|
HC ETHIODOL (LIPIODOL)
|
Facility
IP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Blue Shield of California Commercial |
$525.00
|
| Rate for Payer: Blue Shield of California EPN |
$373.80
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Central Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
IP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$405.00
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$506.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Innovage PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: Riverside University Health MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$424.58
|
| Rate for Payer: Blue Shield of California EPN |
$330.08
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$506.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: IEHP medi-cal |
$263.34
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Innovage PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: Riverside University Health MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
IP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
IP
|
$7,277.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,455.40 |
| Max. Negotiated Rate |
$6,549.30 |
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,821.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,910.80
|
| Rate for Payer: Galaxy Health WC |
$6,185.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,366.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,549.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,853.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,455.40
|
| Rate for Payer: Multiplan Commercial |
$5,457.75
|
| Rate for Payer: Networks By Design Commercial |
$4,730.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,185.45
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
OP
|
$7,277.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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: BCBS Transplant Transplant |
$4,366.20
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,821.60
|
| Rate for Payer: Cigna of CA PPO |
$5,384.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,185.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,366.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,549.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,457.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,853.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,455.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,457.75
|
| Rate for Payer: Networks By Design Commercial |
$4,730.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,185.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,366.20
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,366.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,638.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,638.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,638.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| 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: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.69
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EVAL AUD REHAB STATUS 1ST HR
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
905601903
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC EVAL AUD REHAB STATUS ADD 15 M
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
905601904
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.75
|
| 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: BCBS Transplant Transplant |
$51.00
|
| 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 |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.75
|
| Rate for Payer: IEHP medi-cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.85
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: Riverside University Health MISP |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| 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 |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC EVAL CENT AUD FUNC 1ST HR.
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
905601905
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$446.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$446.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$341.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.69
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| 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 Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EVAL CENT AUD FUNC 1ST HR.
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
905601905
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC EVAL CENT AUD FUNC ADD 15 MIN
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
905601906
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$51.00
|
| 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 |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.75
|
| Rate for Payer: IEHP medi-cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.85
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: Riverside University Health MISP |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| 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 |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC EVAL CENT AUD FUNC ADD 15 MIN
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
905601906
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
IP
|
$802.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$721.80 |
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Central Health Plan Commercial |
$641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$721.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.40
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
|
|
HC EVAL FOR PRESCRIPT VOICE PROST
|
Facility
OP
|
$802.00
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
905601758
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,040.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,040.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$681.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$441.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$441.10
|
| 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: BCBS Transplant Transplant |
$481.20
|
| 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 |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Central Health Plan Commercial |
$641.60
|
| Rate for Payer: Cigna of CA HMO |
$513.28
|
| Rate for Payer: Cigna of CA PPO |
$593.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$681.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$721.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$601.50
|
| Rate for Payer: IEHP medi-cal |
$280.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.82
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$481.20
|
| Rate for Payer: Riverside University Health MISP |
$320.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$481.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$481.20
|
| 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 |
$681.70
|
| Rate for Payer: Vantage Medical Group Senior |
$681.70
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.97
|
| Rate for Payer: BCBS Transplant Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.65
|
| Rate for Payer: Blue Shield of California EPN |
$6.80
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.50
|
| Rate for Payer: IEHP medi-cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$588.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC EVAL OF FNA INITIAL PG
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800216
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$12,338.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.30
|
| Rate for Payer: BCBS Transplant Transplant |
$193.20
|
| Rate for Payer: Blue Shield of California Commercial |
$199.00
|
| Rate for Payer: Blue Shield of California EPN |
$156.49
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$241.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: IEHP medi-cal |
$352.13
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Innovage PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: Riverside University Health MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,338.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC EVAL OF FNA INITIAL PG
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800216
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Central Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,191.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$666.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,125.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$728.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$728.20
|
| 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: BCBS Transplant Transplant |
$794.40
|
| 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 |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: Cigna of CA HMO |
$847.36
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,125.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$993.00
|
| Rate for Payer: IEHP medi-cal |
$463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.84
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$794.40
|
| Rate for Payer: Riverside University Health MISP |
$529.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$794.40
|
| 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 |
$1,125.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,125.40
|
|
|
HC EVAL OF SWALLOW W/RADIOLOGY
|
Facility
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
905601754
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$1,191.60 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
IP
|
$610.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC EVAL REVAL FOR PRESCRIPT SPCH DEVICE
|
Facility
OP
|
$610.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
905601755
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$370.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.50
|
| 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: BCBS Transplant Transplant |
$366.00
|
| 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 |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$457.50
|
| Rate for Payer: IEHP medi-cal |
$213.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.10
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: Riverside University Health MISP |
$244.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| 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 |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
