|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$59.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.76
|
| Rate for Payer: Blue Shield of California Commercial |
$91.30
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Riverside University Health System MISP |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.04
|
| Rate for Payer: Blue Shield of California Commercial |
$178.79
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Riverside University Health System MISP |
$112.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.04
|
| Rate for Payer: Blue Shield of California Commercial |
$178.79
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Riverside University Health System MISP |
$112.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$59.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.76
|
| Rate for Payer: Blue Shield of California Commercial |
$91.30
|
| Rate for Payer: Blue Shield of California EPN |
$57.46
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Riverside University Health System MISP |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.40
|
| Rate for Payer: Vantage Medical Group Senior |
$122.40
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Central Health Plan Commercial |
$915.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$457.60
|
| Rate for Payer: EPIC Health Plan Senior |
$457.60
|
| Rate for Payer: Galaxy Health WC |
$972.40
|
| Rate for Payer: Global Benefits Group Commercial |
$686.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,029.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$726.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.80
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
| Rate for Payer: Networks By Design Commercial |
$743.60
|
| Rate for Payer: Prime Health Services Commercial |
$972.40
|
|
|
HC O2/CO2 EXHALED AIR ANALYSIS RSPC
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
900894681
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$141.04 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$479.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$665.46
|
| Rate for Payer: Blue Shield of California Commercial |
$720.72
|
| Rate for Payer: Blue Shield of California EPN |
$454.17
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Central Health Plan Commercial |
$915.20
|
| Rate for Payer: Cigna of CA HMO |
$732.16
|
| Rate for Payer: Cigna of CA PPO |
$846.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$791.90
|
| Rate for Payer: EPIC Health Plan Senior |
$527.93
|
| Rate for Payer: Galaxy Health WC |
$972.40
|
| Rate for Payer: Global Benefits Group Commercial |
$686.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,029.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$787.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$726.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
| Rate for Payer: Networks By Design Commercial |
$743.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$479.94
|
| Rate for Payer: Prime Health Services Commercial |
$972.40
|
| Rate for Payer: Prime Health Services Medicare |
$508.74
|
| Rate for Payer: Riverside University Health System MISP |
$527.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$686.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$686.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$479.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
HC O2 UPTAKE REST EXERCISE
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
900801032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$70.52 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.61
|
| Rate for Payer: Blue Shield of California Commercial |
$405.72
|
| Rate for Payer: Blue Shield of California EPN |
$255.67
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC O2 UPTAKE REST INDIRECT
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
900801015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$311.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.69
|
| Rate for Payer: Blue Shield of California Commercial |
$279.09
|
| Rate for Payer: Blue Shield of California EPN |
$175.87
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Cigna of CA HMO |
$283.52
|
| Rate for Payer: Cigna of CA PPO |
$327.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC O2 UPTAKE REST INDIRECT
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
900801015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Adventist Health Commercial |
$88.60
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Central Health Plan Commercial |
$354.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$177.20
|
| Rate for Payer: Galaxy Health WC |
$376.55
|
| Rate for Payer: Global Benefits Group Commercial |
$265.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$398.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$261.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.60
|
| Rate for Payer: Multiplan Commercial |
$332.25
|
| Rate for Payer: Networks By Design Commercial |
$287.95
|
| Rate for Payer: Prime Health Services Commercial |
$376.55
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
IP
|
$5.33
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC OB AIRWAY PRIMARY KIT
|
Facility
|
OP
|
$5.33
|
|
| Hospital Charge Code |
901698560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: Blue Shield of California Commercial |
$3.38
|
| Rate for Payer: Blue Shield of California EPN |
$2.13
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.73
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$2.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4.53
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
OP
|
$247.24
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$222.52 |
| Rate for Payer: Adventist Health Commercial |
$49.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.82
|
| Rate for Payer: Blue Shield of California Commercial |
$156.75
|
| Rate for Payer: Blue Shield of California EPN |
$98.65
|
| Rate for Payer: Cash Price |
$111.26
|
| Rate for Payer: Central Health Plan Commercial |
$197.79
|
| Rate for Payer: Cigna of CA HMO |
$158.23
|
| Rate for Payer: Cigna of CA PPO |
$182.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.90
|
| Rate for Payer: EPIC Health Plan Senior |
$98.90
|
| Rate for Payer: Galaxy Health WC |
$210.15
|
| Rate for Payer: Global Benefits Group Commercial |
$148.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$185.43
|
| Rate for Payer: Networks By Design Commercial |
$160.71
|
| Rate for Payer: Prime Health Services Commercial |
$210.15
|
| Rate for Payer: Riverside University Health System MISP |
$98.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.62
|
| Rate for Payer: United Healthcare All Other HMO |
$123.62
|
| Rate for Payer: United Healthcare HMO Rider |
$123.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.15
|
| Rate for Payer: Vantage Medical Group Senior |
$210.15
|
|
|
HC OB AIRWAY SECONDARY KIT
|
Facility
|
IP
|
$247.24
|
|
| Hospital Charge Code |
901698561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$222.52 |
| Rate for Payer: Adventist Health Commercial |
$49.45
|
| Rate for Payer: Cash Price |
$111.26
|
| Rate for Payer: Central Health Plan Commercial |
$197.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.90
|
| Rate for Payer: EPIC Health Plan Senior |
$98.90
|
| Rate for Payer: Galaxy Health WC |
$210.15
|
| Rate for Payer: Global Benefits Group Commercial |
$148.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.45
|
| Rate for Payer: Multiplan Commercial |
$185.43
|
| Rate for Payer: Networks By Design Commercial |
$160.71
|
| Rate for Payer: Prime Health Services Commercial |
$210.15
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$376.18 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$376.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.55
|
| Rate for Payer: Blue Shield of California Commercial |
$178.92
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Blue Shield of California EPN |
$112.75
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| 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: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.89
|
| Rate for Payer: EPIC Health Plan Senior |
$52.59
|
| Rate for Payer: EPIC Health Plan Senior |
$52.59
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.07
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$50.68
|
| Rate for Payer: Prime Health Services Medicare |
$50.68
|
| Rate for Payer: Riverside University Health System MISP |
$52.59
|
| Rate for Payer: Riverside University Health System MISP |
$52.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.73
|
| Rate for Payer: United Healthcare All Other HMO |
$38.73
|
| Rate for Payer: United Healthcare All Other HMO |
$38.73
|
| Rate for Payer: United Healthcare HMO Rider |
$38.73
|
| Rate for Payer: United Healthcare HMO Rider |
$38.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.59
|
| Rate for Payer: Vantage Medical Group Senior |
$47.81
|
| Rate for Payer: Vantage Medical Group Senior |
$47.81
|
|
|
HC OBSTETRIC PANEL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
900913621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
OP
|
$20.75
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.07
|
| Rate for Payer: Blue Shield of California Commercial |
$13.16
|
| Rate for Payer: Blue Shield of California EPN |
$8.28
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Central Health Plan Commercial |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$13.28
|
| Rate for Payer: Cigna of CA PPO |
$15.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.64
|
| Rate for Payer: Global Benefits Group Commercial |
$12.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
| Rate for Payer: Networks By Design Commercial |
$13.49
|
| Rate for Payer: Prime Health Services Commercial |
$17.64
|
| Rate for Payer: Riverside University Health System MISP |
$8.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.38
|
| Rate for Payer: United Healthcare All Other HMO |
$10.38
|
| Rate for Payer: United Healthcare HMO Rider |
$10.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.64
|
| Rate for Payer: Vantage Medical Group Senior |
$17.64
|
|
|
HC OBTURATOR CAP, HEMOSTSIS 8FR
|
Facility
|
IP
|
$20.75
|
|
| Hospital Charge Code |
901698235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Central Health Plan Commercial |
$16.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.64
|
| Rate for Payer: Global Benefits Group Commercial |
$12.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$15.56
|
| Rate for Payer: Networks By Design Commercial |
$13.49
|
| Rate for Payer: Prime Health Services Commercial |
$17.64
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.16 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,132.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,544.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,197.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.17
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,750.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,750.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.60
|
| Rate for Payer: EPIC Health Plan Senior |
$823.60
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,214.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,441.30
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
| Rate for Payer: Riverside University Health System MISP |
$823.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,750.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,750.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,750.15
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP ADDL FETUS
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816 59
|
| Hospital Charge Code |
906601320
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$411.80 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$823.60
|
| Rate for Payer: EPIC Health Plan Senior |
$823.60
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,214.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
|
|
HC OB ULTRASOUND RPT/FOLLOW-UP SINGLE FETUS
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
906601311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,853.10 |
| Rate for Payer: Adventist Health Commercial |
$411.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,197.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.17
|
| Rate for Payer: Blue Shield of California EPN |
$817.42
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Cash Price |
$926.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,647.20
|
| Rate for Payer: Cigna of CA HMO |
$1,317.76
|
| Rate for Payer: Cigna of CA PPO |
$1,523.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,750.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,235.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,853.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$177.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,307.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,544.25
|
| Rate for Payer: Networks By Design Commercial |
$1,338.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,750.15
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,235.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,235.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
