|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.03
|
| Rate for Payer: Blue Distinction Transplant |
$13.24
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$10.79
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Media |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.91 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$493.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$427.08
|
| Rate for Payer: Blue Distinction Transplant |
$748.80
|
| Rate for Payer: Blue Shield of California Commercial |
$771.26
|
| Rate for Payer: Blue Shield of California EPN |
$606.53
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Central Health Plan Commercial |
$998.40
|
| Rate for Payer: Cigna of CA HMO |
$798.72
|
| Rate for Payer: Cigna of CA PPO |
$923.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,123.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$936.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$748.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Central Health Plan Commercial |
$998.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.20
|
| Rate for Payer: Galaxy Health WC |
$1,060.80
|
| Rate for Payer: Global Benefits Group Commercial |
$748.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,123.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$832.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$811.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,060.80
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$631.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.97
|
| Rate for Payer: Blue Distinction Transplant |
$478.20
|
| Rate for Payer: Blue Shield of California Commercial |
$492.55
|
| Rate for Payer: Blue Shield of California EPN |
$387.34
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: Cigna of CA HMO |
$510.08
|
| Rate for Payer: Cigna of CA PPO |
$589.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$597.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$478.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$478.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.40 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Cash Price |
$358.65
|
| Rate for Payer: Central Health Plan Commercial |
$637.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.80
|
| Rate for Payer: Galaxy Health WC |
$677.45
|
| Rate for Payer: Global Benefits Group Commercial |
$478.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$717.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$531.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.40
|
| Rate for Payer: Multiplan Commercial |
$597.75
|
| Rate for Payer: Networks By Design Commercial |
$518.05
|
| Rate for Payer: Prime Health Services Commercial |
$677.45
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,669.00 |
| Max. Negotiated Rate |
$7,510.50 |
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,338.00
|
| Rate for Payer: Galaxy Health WC |
$7,093.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,510.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,566.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,179.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.00
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
| Rate for Payer: Networks By Design Commercial |
$5,424.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,093.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$534.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,093.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,589.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,589.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,007.00
|
| 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 |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,676.00
|
| Rate for Payer: Cigna of CA PPO |
$6,175.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,093.25
|
| Rate for Payer: Dignity Health Media |
$7,093.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,093.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,338.00
|
| Rate for Payer: Galaxy Health WC |
$7,093.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,510.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,258.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,920.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,566.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.00
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
| Rate for Payer: Networks By Design Commercial |
$5,424.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,093.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,338.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,007.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,007.00
|
| 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 |
$7,093.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,093.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$534.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,093.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,589.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,589.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,007.00
|
| 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 |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,676.00
|
| Rate for Payer: Cigna of CA PPO |
$6,175.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,093.25
|
| Rate for Payer: Dignity Health Media |
$7,093.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,093.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,338.00
|
| Rate for Payer: Galaxy Health WC |
$7,093.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,510.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,258.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,920.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,566.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.00
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
| Rate for Payer: Networks By Design Commercial |
$5,424.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,093.25
|
| Rate for Payer: Riverside University Health System MISP |
$3,338.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,007.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,007.00
|
| 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 |
$7,093.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,093.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,669.00 |
| Max. Negotiated Rate |
$7,510.50 |
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,338.00
|
| Rate for Payer: Galaxy Health WC |
$7,093.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,510.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,566.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,179.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.00
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
| Rate for Payer: Networks By Design Commercial |
$5,424.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,093.25
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,346.00 |
| Max. Negotiated Rate |
$10,557.00 |
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,384.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,692.00
|
| Rate for Payer: Galaxy Health WC |
$9,970.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,469.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.00
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
| Rate for Payer: Networks By Design Commercial |
$7,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,970.50
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$427.86 |
| Max. Negotiated Rate |
$10,557.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,056.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,970.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,451.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,451.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,038.00
|
| 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 |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,384.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,970.50
|
| Rate for Payer: Dignity Health Media |
$9,970.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,970.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,692.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,692.00
|
| Rate for Payer: Galaxy Health WC |
$9,970.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,557.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,797.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,105.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.00
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
| Rate for Payer: Networks By Design Commercial |
$7,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,970.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,692.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,038.00
|
| 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 |
$9,970.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,970.50
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
OP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$427.86 |
| Max. Negotiated Rate |
$10,557.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,056.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,970.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,451.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,451.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,038.00
|
| 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 |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,384.00
|
| Rate for Payer: Cigna of CA PPO |
$8,680.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,970.50
|
| Rate for Payer: Dignity Health Media |
$9,970.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,970.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,692.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,692.00
|
| Rate for Payer: Galaxy Health WC |
$9,970.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,557.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,797.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,105.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.00
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
| Rate for Payer: Networks By Design Commercial |
$7,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,970.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,692.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,038.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,038.00
|
| 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 |
$9,970.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,970.50
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
|
IP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,346.00 |
| Max. Negotiated Rate |
$10,557.00 |
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,384.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,692.00
|
| Rate for Payer: Galaxy Health WC |
$9,970.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,557.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,823.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,469.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.00
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
| Rate for Payer: Networks By Design Commercial |
$7,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,970.50
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Central Health Plan Commercial |
$852.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.40
|
| Rate for Payer: Galaxy Health WC |
$906.10
|
| Rate for Payer: Global Benefits Group Commercial |
$639.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$799.50
|
| Rate for Payer: Networks By Design Commercial |
$692.90
|
| Rate for Payer: Prime Health Services Commercial |
$906.10
|
|
|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.81 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$584.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$545.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$665.38
|
| Rate for Payer: Blue Distinction Transplant |
$639.60
|
| Rate for Payer: Blue Shield of California Commercial |
$658.79
|
| Rate for Payer: Blue Shield of California EPN |
$518.08
|
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Cash Price |
$479.70
|
| Rate for Payer: Central Health Plan Commercial |
$852.80
|
| Rate for Payer: Cigna of CA HMO |
$682.24
|
| Rate for Payer: Cigna of CA PPO |
$788.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$906.10
|
| Rate for Payer: Dignity Health Media |
$906.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$906.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$426.40
|
| Rate for Payer: Galaxy Health WC |
$906.10
|
| Rate for Payer: Global Benefits Group Commercial |
$639.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$799.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$373.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$799.50
|
| Rate for Payer: Networks By Design Commercial |
$692.90
|
| Rate for Payer: Prime Health Services Commercial |
$906.10
|
| Rate for Payer: Riverside University Health System MISP |
$426.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.00
|
| Rate for Payer: United Healthcare All Other HMO |
$533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$533.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$906.10
|
| Rate for Payer: Vantage Medical Group Senior |
$906.10
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$722.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| 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 |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$722.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| 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 |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC JO-1 AUTO AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.13
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903207680
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903200166
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$501.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$495.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$528.64
|
| Rate for Payer: Cigna of CA PPO |
$611.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Media |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$619.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.66
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Riverside University Health System MISP |
$330.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC JOB SITE ASSESSMENT PT
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 97680
|
| Hospital Charge Code |
903200166
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
|
