|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
OP
|
$6,954.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,390.80 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,172.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,129.30
|
| Rate for Payer: Cash Price |
$3,129.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,563.20
|
| Rate for Payer: Cigna of CA PPO |
$5,145.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| 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 |
$5,910.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,172.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,258.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,215.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (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 |
$4,638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,649.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,390.80
|
| 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 |
$5,215.50
|
| Rate for Payer: Networks By Design Commercial |
$4,520.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,910.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,172.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 FALLOPIAN TUBE RECANALIZATION
|
Facility
|
IP
|
$6,954.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,390.80 |
| Max. Negotiated Rate |
$6,258.60 |
| Rate for Payer: Cash Price |
$3,129.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,563.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,781.60
|
| Rate for Payer: Galaxy Health WC |
$5,910.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,172.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,258.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,649.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,390.80
|
| Rate for Payer: Multiplan Commercial |
$5,215.50
|
| Rate for Payer: Networks By Design Commercial |
$4,520.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,910.90
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: Blue Distinction Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$252.23
|
| Rate for Payer: Blue Shield of California EPN |
$196.09
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$256.64
|
| Rate for Payer: Cigna of CA PPO |
$296.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: Blue Distinction Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$252.23
|
| Rate for Payer: Blue Shield of California EPN |
$196.09
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$256.64
|
| Rate for Payer: Cigna of CA PPO |
$296.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
|
|
HC FAMILY PSYCH WO PT 50 MIN
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
900100708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$260.65
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.18
|
| Rate for Payer: Blue Shield of California EPN |
$205.38
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC FAMILY PSYCH W PT 50 MIN
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
900100709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.18
|
| Rate for Payer: Blue Shield of California EPN |
$205.38
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC FAMILY THERAPY WITH PATIENT
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804050
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.77
|
| Rate for Payer: Blue Distinction Transplant |
$276.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.34
|
| Rate for Payer: Blue Shield of California EPN |
$224.94
|
| Rate for Payer: Caremore Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.82
|
| Rate for Payer: Dignity Health Media |
$199.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$199.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.21
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$345.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$199.21
|
| Rate for Payer: InnovAge PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.94
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Medicare |
$211.16
|
| Rate for Payer: Riverside University Health System MISP |
$219.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC FAMILY THERAPY WITH PATIENT
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
907804050
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$14.43
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.64
|
| Rate for Payer: Dignity Health Media |
$14.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.43
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: InnovAge PACE Commercial |
$21.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.34
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.69
|
| Rate for Payer: United Healthcare All Other HMO |
$11.69
|
| Rate for Payer: United Healthcare HMO Rider |
$11.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Senior |
$14.43
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN CMV
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$80.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.65
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$13.42
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Media |
$13.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.42
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: InnovAge PACE Commercial |
$20.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$14.23
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC FA STAIN CMV
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$82.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.38
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC FA STAIN INFLUENZA A
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
