|
HC GRAFT, IM, CONDUIT
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906820070
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$470.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$442.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA PPO |
$545.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Media |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$552.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC GRAM POSITIVE SENSITIVITY MIC
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.71
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Media |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: InnovAge PACE Commercial |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Riverside University Health System MISP |
$9.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC GRAM POSITIVE SENSITIVITY MIC
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.88
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Caremore Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC GROUP PSYCH NOT MULTI FAMILY
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
900100711
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.36
|
| Rate for Payer: Blue Distinction Transplant |
$263.40
|
| Rate for Payer: Blue Shield of California Commercial |
$276.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.67
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: Cigna of CA HMO |
$280.96
|
| Rate for Payer: Cigna of CA PPO |
$324.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$329.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.50
|
| Rate for Payer: United Healthcare All Other HMO |
$219.50
|
| Rate for Payer: United Healthcare HMO Rider |
$219.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC GROUP PSYCH NOT MULTI FAMILY
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
900100711
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.36
|
| Rate for Payer: Blue Distinction Transplant |
$263.40
|
| Rate for Payer: Blue Shield of California Commercial |
$276.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.67
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: Cigna of CA HMO |
$280.96
|
| Rate for Payer: Cigna of CA PPO |
$324.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$329.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.50
|
| Rate for Payer: United Healthcare All Other HMO |
$219.50
|
| Rate for Payer: United Healthcare HMO Rider |
$219.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC GROUP PSYCH NOT MULTI FAMILY
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
900100711
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$87.80 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.60
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
|
|
HC GROUP PSYCH NOT MULTI FAMILY
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
900100711
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.80 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.60
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
|
|
HC GROUP PSYCHOTHERAPY-MOTIVATION
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804018
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC GROUP PSYCHOTHERAPY-MOTIVATION
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804018
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.01
|
| Rate for Payer: Blue Distinction Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.42
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC GROUP THERAPY 60 MIN
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
903100090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.36
|
| Rate for Payer: Blue Distinction Transplant |
$263.40
|
| Rate for Payer: Blue Shield of California Commercial |
$276.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.67
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: Cigna of CA HMO |
$280.96
|
| Rate for Payer: Cigna of CA PPO |
$324.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$329.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$263.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$263.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.50
|
| Rate for Payer: United Healthcare All Other HMO |
$219.50
|
| Rate for Payer: United Healthcare HMO Rider |
$219.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC GROUP THERAPY 60 MIN
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
903100090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$87.80 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Central Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.60
|
| Rate for Payer: Galaxy Health WC |
$373.15
|
| Rate for Payer: Global Benefits Group Commercial |
$263.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$395.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.80
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: Networks By Design Commercial |
$285.35
|
| Rate for Payer: Prime Health Services Commercial |
$373.15
|
|
|
HC GROWTH EXTENSION PER BAR
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT L2760
|
| Hospital Charge Code |
905352760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.31
|
| Rate for Payer: Blue Distinction Transplant |
$71.40
|
| Rate for Payer: Blue Shield of California Commercial |
$89.25
|
| Rate for Payer: Blue Shield of California EPN |
$64.74
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Cigna of CA HMO |
$83.30
|
| Rate for Payer: Cigna of CA PPO |
$83.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.15
|
| Rate for Payer: Dignity Health Media |
$101.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$89.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.79
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Riverside University Health System MISP |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other HMO |
$59.50
|
| Rate for Payer: United Healthcare HMO Rider |
$59.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.15
|
| Rate for Payer: Vantage Medical Group Senior |
$101.15
|
|
|
HC GROWTH EXTENSION PER BAR
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT L2760
|
| Hospital Charge Code |
905352760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Blue Shield of California EPN |
$63.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Central Health Plan Commercial |
$95.20
|
| Rate for Payer: Cigna of CA HMO |
$83.30
|
| Rate for Payer: Cigna of CA PPO |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.60
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Networks By Design Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.93
|
| Rate for Payer: United Healthcare All Other HMO |
$43.89
|
| Rate for Payer: United Healthcare HMO Rider |
$42.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.27
|
|
|
HC GUID CATH/NEURO ENDOVASCULAR
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GUID CATH/NEURO ENDOVASCULAR
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC GUIDE 18GA X 145CM
|
Facility
|
OP
|
$110.12
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.06
|
| Rate for Payer: Blue Distinction Transplant |
$66.07
|
| Rate for Payer: Blue Shield of California Commercial |
$69.27
|
| Rate for Payer: Blue Shield of California EPN |
$53.85
|
| Rate for Payer: Cash Price |
$49.55
|
| Rate for Payer: Cash Price |
$49.55
|
| Rate for Payer: Central Health Plan Commercial |
$88.10
|
| Rate for Payer: Cigna of CA HMO |
$70.48
|
| Rate for Payer: Cigna of CA PPO |
$81.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.60
|
| Rate for Payer: Dignity Health Media |
$93.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.05
|
| Rate for Payer: Galaxy Health WC |
$93.60
|
| Rate for Payer: Global Benefits Group Commercial |
$66.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.11
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.02
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: Networks By Design Commercial |
$71.58
|
| Rate for Payer: Prime Health Services Commercial |
$93.60
|
| Rate for Payer: Riverside University Health System MISP |
$44.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.06
|
| Rate for Payer: United Healthcare All Other HMO |
$55.06
|
| Rate for Payer: United Healthcare HMO Rider |
$55.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.60
|
| Rate for Payer: Vantage Medical Group Senior |
$93.60
|
|
|
HC GUIDE 18GA X 145CM
|
Facility
|
IP
|
$110.12
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$99.11 |
| Rate for Payer: Cash Price |
$49.55
|
| Rate for Payer: Central Health Plan Commercial |
$88.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.05
|
| Rate for Payer: Galaxy Health WC |
$93.60
|
| Rate for Payer: Global Benefits Group Commercial |
$66.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.02
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: Networks By Design Commercial |
$71.58
|
| Rate for Payer: Prime Health Services Commercial |
$93.60
|
|
|
HC GUIDE ANGLED .035"X150CM
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.09
|
| Rate for Payer: Blue Shield of California EPN |
$102.69
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Media |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC GUIDE ANGLED .035"X150CM
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901602721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC GUIDE ARROW .32X60CM SOFT TIP
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901606106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC GUIDE BENTSON 035"X145CM
|
Facility
|
IP
|
$105.72
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901603846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$95.15 |
| Rate for Payer: Cash Price |
$47.57
|
| Rate for Payer: Central Health Plan Commercial |
$84.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.29
|
| Rate for Payer: Galaxy Health WC |
$89.86
|
| Rate for Payer: Global Benefits Group Commercial |
$63.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$79.29
|
| Rate for Payer: Networks By Design Commercial |
$68.72
|
| Rate for Payer: Prime Health Services Commercial |
$89.86
|
|
