|
HC INC & REM F/B SUBQ TIS COMPL
|
Facility
OP
|
$8,211.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
900501004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,389.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,926.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Cash Price |
$3,694.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,568.80
|
| Rate for Payer: Cigna of CA PPO |
$6,076.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,979.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,926.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,389.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,158.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,476.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,642.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,158.25
|
| Rate for Payer: Networks By Design Commercial |
$5,337.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,979.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,926.60
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,926.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,105.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,105.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,105.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,105.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
OP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$368.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,105.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,159.25
|
| Rate for Payer: Blue Shield of California EPN |
$901.23
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,474.40
|
| Rate for Payer: Cigna of CA HMO |
$1,179.52
|
| Rate for Payer: Cigna of CA PPO |
$1,363.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,658.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,382.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,382.25
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,105.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,105.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$921.50
|
| Rate for Payer: United Healthcare All Other HMO |
$921.50
|
| Rate for Payer: United Healthcare HMO Rider |
$921.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$921.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
IP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.60 |
| Max. Negotiated Rate |
$1,658.70 |
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,658.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.60
|
| Rate for Payer: Multiplan Commercial |
$1,382.25
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
IP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$368.60 |
| Max. Negotiated Rate |
$1,658.70 |
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,658.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.60
|
| Rate for Payer: Multiplan Commercial |
$1,382.25
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
|
|
HC INC & REM FB SUBQ TISSUE
|
Facility
OP
|
$1,843.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
900501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,105.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Cash Price |
$829.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,474.40
|
| Rate for Payer: Cigna of CA PPO |
$1,363.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,566.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,658.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,382.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,229.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,382.25
|
| Rate for Payer: Networks By Design Commercial |
$1,197.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,566.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,105.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$921.50
|
| Rate for Payer: United Healthcare All Other HMO |
$921.50
|
| Rate for Payer: United Healthcare HMO Rider |
$921.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$921.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$494.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$320.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$349.20
|
| 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 |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Central Health Plan Commercial |
$465.60
|
| Rate for Payer: Cigna of CA PPO |
$430.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$494.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$523.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$436.50
|
| Rate for Payer: IEHP medi-cal |
$203.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$436.50
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.20
|
| Rate for Payer: Riverside University Health MISP |
$232.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.20
|
| 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 |
$494.70
|
| Rate for Payer: Vantage Medical Group Senior |
$494.70
|
|
|
HC INCSNAL BX SKIN EA SEP/ADD LSN
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
900511107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Central Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$523.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$436.50
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
OP
|
$9,326.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,927.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,129.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,129.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,595.60
|
| 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: Cash Price |
$4,196.70
|
| Rate for Payer: Cash Price |
$4,196.70
|
| Rate for Payer: Cash Price |
$4,196.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,460.80
|
| Rate for Payer: Cigna of CA PPO |
$6,901.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,927.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,730.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,730.40
|
| Rate for Payer: Galaxy Health WC |
$7,927.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,595.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,393.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,994.50
|
| Rate for Payer: IEHP medi-cal |
$3,264.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,220.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.20
|
| Rate for Payer: Multiplan Commercial |
$6,994.50
|
| Rate for Payer: Networks By Design Commercial |
$6,061.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,595.60
|
| Rate for Payer: Riverside University Health MISP |
$3,730.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,595.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,927.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,927.10
|
|
|
HC IND ABTN GT 1 IA INJ INCL HA
|
Facility
IP
|
$9,326.00
|
|
|
Service Code
|
CPT 59850
|
| Hospital Charge Code |
909009850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,196.70
|
| Rate for Payer: Cash Price |
$4,196.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,460.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,730.40
|
| Rate for Payer: Galaxy Health WC |
$7,927.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,595.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,393.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,220.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,865.20
|
| Rate for Payer: Multiplan Commercial |
$6,994.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,927.10
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| 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: 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 INDIV BRIEF THERAPY
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$460.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$199.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$460.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$298.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.21
|
| 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: BCBS Transplant 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 |
$199.21
|
| 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 |
$298.82
|
| 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 |
$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 Transplant Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.70
|
| Rate for Payer: IEHP medi-cal |
$328.70
|
| Rate for Payer: IEHP Medicare Advantage |
$199.21
|
| Rate for Payer: Innovage PACE Commercial |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| 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 |
$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 |
$211.16
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: Riverside University Health MISP |
$219.13
|
| 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 |
$298.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.13
|
| Rate for Payer: Vantage Medical Group Senior |
$199.21
|
|
|
HC INDIV THERAPY
|
Facility
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$65.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: IEHP medi-cal |
$183.76
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: Riverside University Health 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 INDIV THERAPY
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
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: 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 INDR ARROW FLEX 24 CM
|
Facility
OP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$364.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.19
|
| Rate for Payer: BCBS Transplant Transplant |
$42.85
|
| Rate for Payer: Blue Shield of California Commercial |
$44.92
|
| Rate for Payer: Blue Shield of California EPN |
$34.92
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.56
|
| Rate for Payer: IEHP medi-cal |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: Riverside University Health MISP |
$28.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
IP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
OP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$290.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.53
|
| Rate for Payer: BCBS Transplant Transplant |
$317.40
|
| Rate for Payer: Blue Shield of California Commercial |
$332.74
|
| Rate for Payer: Blue Shield of California EPN |
$258.68
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$396.75
|
| Rate for Payer: IEHP medi-cal |
$185.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: Riverside University Health MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
IP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
OP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$364.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$314.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.45
|
| Rate for Payer: BCBS Transplant Transplant |
$221.85
|
| Rate for Payer: Blue Shield of California Commercial |
$232.57
|
| Rate for Payer: Blue Shield of California EPN |
$180.81
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: Cigna of CA HMO |
$236.64
|
| Rate for Payer: Cigna of CA PPO |
$273.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$277.31
|
| Rate for Payer: IEHP medi-cal |
$129.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: Riverside University Health MISP |
$147.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$184.88
|
| Rate for Payer: United Healthcare All Other HMO |
$184.88
|
| Rate for Payer: United Healthcare HMO Rider |
$184.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$184.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.29
|
| Rate for Payer: Vantage Medical Group Senior |
$314.29
|
|
|
HC INDR COOK MULLINS 48CM
|
Facility
IP
|
$369.75
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906811765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$332.78 |
| Rate for Payer: Cash Price |
$166.39
|
| Rate for Payer: Central Health Plan Commercial |
$295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.90
|
| Rate for Payer: Galaxy Health WC |
$314.29
|
| Rate for Payer: Global Benefits Group Commercial |
$221.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$332.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.95
|
| Rate for Payer: Multiplan Commercial |
$277.31
|
| Rate for Payer: Networks By Design Commercial |
$240.34
|
| Rate for Payer: Prime Health Services Commercial |
$314.29
|
|
|
HC INDR CORDIS AVANTI 035/038
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$61.50
|
| Rate for Payer: IEHP medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: Riverside University Health 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 INDR CORDIS AVANTI 035/038
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906811762
|
|
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: 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 INDR MICROPUNCTURE NEEDLE
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.90
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.48
|
| Rate for Payer: Blue Shield of California EPN |
$58.68
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: IEHP medi-cal |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC INDR MICROPUNCTURE NEEDLE
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
IP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
|
|
HC INDR SHTH STJ FASTCATH EP
|
Facility
OP
|
$648.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$550.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$356.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$356.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.84
|
| Rate for Payer: BCBS Transplant Transplant |
$388.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.59
|
| Rate for Payer: Blue Shield of California EPN |
$316.87
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$550.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$259.20
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$486.00
|
| Rate for Payer: IEHP medi-cal |
$226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: Riverside University Health MISP |
$259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$324.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$550.80
|
| Rate for Payer: Vantage Medical Group Senior |
$550.80
|
|
