|
HC INSTILL RX AGENT VIA NEPH TUBE
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 50391
|
| Hospital Charge Code |
907201118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.92 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$309.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$506.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.32
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$470.70
|
| 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 |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| 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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$9,702.90 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,547.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,220.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,331.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,851.45
|
| Rate for Payer: Cash Price |
$4,851.45
|
| Rate for Payer: Cash Price |
$4,851.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,624.80
|
| Rate for Payer: Cigna of CA HMO |
$6,899.84
|
| Rate for Payer: Cigna of CA PPO |
$7,977.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$9,163.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,468.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,702.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,190.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,156.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$8,085.75
|
| Rate for Payer: Networks By Design Commercial |
$7,007.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,163.85
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,468.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,468.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$12,398.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$11,158.20 |
| Rate for Payer: Adventist Health Commercial |
$2,479.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,529.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,281.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,579.10
|
| Rate for Payer: Cash Price |
$5,579.10
|
| Rate for Payer: Cash Price |
$5,579.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,918.40
|
| Rate for Payer: Cigna of CA HMO |
$7,934.72
|
| Rate for Payer: Cigna of CA PPO |
$9,174.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$10,538.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,158.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,269.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,479.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$9,298.50
|
| Rate for Payer: Networks By Design Commercial |
$8,058.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,538.30
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,438.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,156.20 |
| Max. Negotiated Rate |
$9,702.90 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Cash Price |
$4,851.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,624.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,312.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,312.40
|
| Rate for Payer: Galaxy Health WC |
$9,163.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,468.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,702.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,190.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,107.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,673.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,156.20
|
| Rate for Payer: Multiplan Commercial |
$8,085.75
|
| Rate for Payer: Networks By Design Commercial |
$7,007.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,163.85
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$12,398.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,479.60 |
| Max. Negotiated Rate |
$11,158.20 |
| Rate for Payer: Adventist Health Commercial |
$2,479.60
|
| Rate for Payer: Cash Price |
$5,579.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,918.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,959.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,959.20
|
| Rate for Payer: Galaxy Health WC |
$10,538.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,438.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,158.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,723.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,674.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,479.60
|
| Rate for Payer: Multiplan Commercial |
$9,298.50
|
| Rate for Payer: Networks By Design Commercial |
$8,058.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,538.30
|
|
|
HC INSULIN
|
Facility
|
OP
|
$41.08
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$83.16 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$24.94
|
| Rate for Payer: Blue Shield of California EPN |
$16.31
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Central Health Plan Commercial |
$32.86
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$11.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: InnovAge PACE Commercial |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$30.81
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.43
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Prime Health Services Medicare |
$12.12
|
| Rate for Payer: Riverside University Health System MISP |
$12.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INSULIN
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$236.47
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Adventist Health Commercial |
$47.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$300.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.94
|
| Rate for Payer: Blue Shield of California Commercial |
$143.54
|
| Rate for Payer: Blue Shield of California EPN |
$93.88
|
| Rate for Payer: Cash Price |
$106.41
|
| Rate for Payer: Cash Price |
$106.41
|
| Rate for Payer: Central Health Plan Commercial |
$189.18
|
| Rate for Payer: Cigna of CA HMO |
$151.34
|
| Rate for Payer: Cigna of CA PPO |
$174.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.73
|
| Rate for Payer: EPIC Health Plan Senior |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$201.00
|
| Rate for Payer: Global Benefits Group Commercial |
$141.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$67.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: InnovAge PACE Commercial |
$61.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.32
|
| Rate for Payer: Multiplan Commercial |
$177.35
|
| Rate for Payer: Networks By Design Commercial |
$153.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41.28
|
| Rate for Payer: Prime Health Services Commercial |
$201.00
|
| Rate for Payer: Prime Health Services Medicare |
$43.76
|
| Rate for Payer: Riverside University Health System MISP |
$45.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.44
|
| Rate for Payer: United Healthcare All Other HMO |
$33.44
|
| Rate for Payer: United Healthcare HMO Rider |
$33.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INTACT PTH
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$686.70 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Cash Price |
$343.35
|
| Rate for Payer: Central Health Plan Commercial |
$610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.20
|
| Rate for Payer: EPIC Health Plan Senior |
$305.20
|
| Rate for Payer: Galaxy Health WC |
$648.55
|
| Rate for Payer: Global Benefits Group Commercial |
$457.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$686.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
| Rate for Payer: Networks By Design Commercial |
$495.95
|
| Rate for Payer: Prime Health Services Commercial |
$648.55
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$861.30 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Central Health Plan Commercial |
$765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.40
|
| Rate for Payer: Multiplan Commercial |
$717.75
|
| Rate for Payer: Networks By Design Commercial |
$622.05
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$1,142.54 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$581.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.31
|
| Rate for Payer: Blue Shield of California Commercial |
$580.90
|
| Rate for Payer: Blue Shield of California EPN |
$379.93
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Central Health Plan Commercial |
$765.60
|
| Rate for Payer: Cigna of CA HMO |
$612.48
|
| Rate for Payer: Cigna of CA PPO |
$708.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$717.75
|
| Rate for Payer: Networks By Design Commercial |
$622.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
IP
|
$11,810.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,362.00 |
| Max. Negotiated Rate |
$10,629.00 |
| Rate for Payer: Adventist Health Commercial |
$2,362.00
|
| Rate for Payer: Cash Price |
$5,314.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,724.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,724.00
|
| Rate for Payer: Galaxy Health WC |
$10,038.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,086.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,629.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,877.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,499.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,310.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,362.00
|
| Rate for Payer: Multiplan Commercial |
$8,857.50
|
| Rate for Payer: Networks By Design Commercial |
$7,676.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,038.50
|
|
|
HC INTENSITY MOD RADIO TX PLAN
|
Facility
|
OP
|
$11,810.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
909100275
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,124.60 |
| Max. Negotiated Rate |
$10,629.00 |
| Rate for Payer: Adventist Health Commercial |
$2,362.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,738.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,172.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,541.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,168.67
|
| Rate for Payer: Blue Shield of California EPN |
$4,688.57
|
| Rate for Payer: Cash Price |
$5,314.50
|
| Rate for Payer: Cash Price |
$5,314.50
|
| Rate for Payer: Cash Price |
$5,314.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,448.00
|
| Rate for Payer: Cigna of CA HMO |
$7,558.40
|
| Rate for Payer: Cigna of CA PPO |
$8,739.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$10,038.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,086.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,629.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,127.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: InnovAge PACE Commercial |
$2,607.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,877.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,362.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,329.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| Rate for Payer: Multiplan Commercial |
$8,857.50
|
| Rate for Payer: Networks By Design Commercial |
$7,676.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Prime Health Services Commercial |
$10,038.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,842.82
|
| Rate for Payer: Riverside University Health System MISP |
$1,912.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,086.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,738.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC INTENSIVE OP SHIELD/ADOL/CHILD
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300010
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.60
|
| Rate for Payer: EPIC Health Plan Senior |
$313.60
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$485.30
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
|
|
HC INTENSIVE OP SHIELD/ADOL/CHILD
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907300010
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$379.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.44
|
| Rate for Payer: Blue Shield of California Commercial |
$479.02
|
| Rate for Payer: Blue Shield of California EPN |
$312.82
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Central Health Plan Commercial |
$627.20
|
| Rate for Payer: Cigna of CA HMO |
$501.76
|
| Rate for Payer: Cigna of CA PPO |
$580.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$666.40
|
| Rate for Payer: Global Benefits Group Commercial |
$470.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$705.60
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Networks By Design Commercial |
$509.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$666.40
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$470.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$392.00
|
| Rate for Payer: United Healthcare All Other HMO |
$392.00
|
| Rate for Payer: United Healthcare HMO Rider |
$392.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.13
|
| Rate for Payer: Blue Shield of California Commercial |
$147.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.98
|
| Rate for Payer: InnovAge PACE Commercial |
$121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.13
|
| Rate for Payer: Blue Shield of California Commercial |
$147.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.56
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.98
|
| Rate for Payer: InnovAge PACE Commercial |
$121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$121.00
|
| Rate for Payer: United Healthcare HMO Rider |
$121.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC INTERACTIVE COMPLEXITY
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
900100714
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC INTERACTIVE GROUP THERAPY
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804000
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$262.73
|
| Rate for Payer: Blue Shield of California EPN |
$171.57
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$275.20
|
| Rate for Payer: Cigna of CA PPO |
$318.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC INTERACTIVE GROUP THERAPY
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804000
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$1,804.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$1,402.00
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,443.20
|
| Rate for Payer: Cigna of CA HMO |
$1,154.56
|
| Rate for Payer: Cigna of CA PPO |
$1,334.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,533.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,082.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,623.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,203.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,353.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,172.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,533.40
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,082.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$902.00
|
| Rate for Payer: United Healthcare All Other HMO |
$902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$902.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$902.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
IP
|
$1,804.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.80 |
| Max. Negotiated Rate |
$1,623.60 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,443.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.60
|
| Rate for Payer: EPIC Health Plan Senior |
$721.60
|
| Rate for Payer: Galaxy Health WC |
$1,533.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,082.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,623.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,203.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$687.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,116.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.80
|
| Rate for Payer: Multiplan Commercial |
$1,353.00
|
| Rate for Payer: Networks By Design Commercial |
$1,172.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,533.40
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
OP
|
$13,880.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.16 |
| Max. Negotiated Rate |
$12,492.00 |
| Rate for Payer: Adventist Health Commercial |
$2,776.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$6,246.00
|
| Rate for Payer: Cash Price |
$6,246.00
|
| Rate for Payer: Cash Price |
$6,246.00
|
| Rate for Payer: Cash Price |
$6,246.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,104.00
|
| Rate for Payer: Cigna of CA HMO |
$8,883.20
|
| Rate for Payer: Cigna of CA PPO |
$10,271.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$11,798.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,492.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,257.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,776.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$10,410.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$9,022.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$11,798.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,328.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,940.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,940.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,940.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,940.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTERDENTAL WIRING,OTH THN FRX
|
Facility
|
IP
|
$13,880.00
|
|
|
Service Code
|
CPT 21497
|
| Hospital Charge Code |
900501322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,776.00 |
| Max. Negotiated Rate |
$12,492.00 |
| Rate for Payer: Adventist Health Commercial |
$2,776.00
|
| Rate for Payer: Cash Price |
$6,246.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,552.00
|
| Rate for Payer: Galaxy Health WC |
$11,798.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,492.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,257.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,288.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,591.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,776.00
|
| Rate for Payer: Multiplan Commercial |
$10,410.00
|
| Rate for Payer: Networks By Design Commercial |
$9,022.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,798.00
|
|
