|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
OP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,496.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,496.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,962.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,104.80
|
| Rate for Payer: Cigna of CA HMO |
$4,883.84
|
| Rate for Payer: Cigna of CA PPO |
$5,646.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,946.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,496.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,341.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,419.36
|
| Rate for Payer: EPIC Health Plan Senior |
$4,946.24
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,867.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,374.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$662.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,845.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,295.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,025.42
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,496.58
|
| Rate for Payer: Preferred Health Network WC |
$7,104.27
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,766.37
|
| Rate for Payer: Prime Health Services WC |
$6,891.14
|
| Rate for Payer: Riverside University Health System MISP |
$4,946.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,578.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,815.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,815.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,815.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,815.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,496.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,744.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,946.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4,496.58
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,526.20 |
| Max. Negotiated Rate |
$6,867.90 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,104.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,341.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.40
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,867.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,845.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,502.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.20
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Cash Price |
$6,995.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,871.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,643.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,172.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.23
|
| 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 |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| 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 |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| 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 |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| 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 PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.07
|
| 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 |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.89
|
| Rate for Payer: Blue Shield of California Commercial |
$107.10
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| 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 |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| 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 |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| 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 PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC PHYSICIAN CONF PARTICIP 30 MIN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
908600144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$305.74 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.46
|
| Rate for Payer: Blue Shield of California Commercial |
$81.15
|
| Rate for Payer: Blue Shield of California EPN |
$51.07
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$1,074.60 |
| Rate for Payer: Adventist Health Commercial |
$238.80
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Central Health Plan Commercial |
$955.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$477.60
|
| Rate for Payer: Galaxy Health WC |
$1,014.90
|
| Rate for Payer: Global Benefits Group Commercial |
$716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,074.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$758.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$704.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$895.50
|
| Rate for Payer: Networks By Design Commercial |
$776.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.90
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$238.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,014.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$656.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,378.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$694.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Central Health Plan Commercial |
$955.20
|
| Rate for Payer: Cigna of CA HMO |
$776.10
|
| Rate for Payer: Cigna of CA PPO |
$883.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,014.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,014.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,014.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$835.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$477.60
|
| Rate for Payer: Galaxy Health WC |
$1,014.90
|
| Rate for Payer: Global Benefits Group Commercial |
$716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,074.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$386.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$758.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$704.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$835.80
|
| Rate for Payer: Multiplan Commercial |
$895.50
|
| Rate for Payer: Networks By Design Commercial |
$776.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.90
|
| Rate for Payer: Riverside University Health System MISP |
$477.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,014.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,014.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,014.90
|
|
