|
HC POLYS MICRO EXAM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| 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 POLYSOM LT 6 YRS 4/GT PARAMTRS
|
Facility
|
OP
|
$5,746.00
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
903600042
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$5,763.32 |
| Rate for Payer: Adventist Health Commercial |
$1,149.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,634.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,763.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,342.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,619.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,281.16
|
| Rate for Payer: Cash Price |
$2,585.70
|
| Rate for Payer: Cash Price |
$2,585.70
|
| Rate for Payer: Cash Price |
$2,585.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,596.80
|
| Rate for Payer: Cigna of CA HMO |
$3,677.44
|
| Rate for Payer: Cigna of CA PPO |
$4,252.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,022.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$4,884.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,171.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,628.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,648.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,798.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$4,309.50
|
| Rate for Payer: Networks By Design Commercial |
$3,734.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,884.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,447.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,447.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC POLYSOM LT 6 YRS 4/GT PARAMTRS
|
Facility
|
IP
|
$5,746.00
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
903600042
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,149.20 |
| Max. Negotiated Rate |
$5,171.40 |
| Rate for Payer: Adventist Health Commercial |
$1,149.20
|
| Rate for Payer: Cash Price |
$2,585.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,022.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,298.40
|
| Rate for Payer: Galaxy Health WC |
$4,884.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,171.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,648.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,390.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.20
|
| Rate for Payer: Multiplan Commercial |
$4,309.50
|
| Rate for Payer: Networks By Design Commercial |
$3,734.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,884.10
|
|
|
HC POLYSOM LT 6 YRS CPAP/BILVL
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
903600043
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$2,197.80 |
| Rate for Payer: Adventist Health Commercial |
$488.40
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,953.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,709.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.80
|
| Rate for Payer: EPIC Health Plan Senior |
$976.80
|
| Rate for Payer: Galaxy Health WC |
$2,075.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,197.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,550.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,440.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.40
|
| Rate for Payer: Multiplan Commercial |
$1,831.50
|
| Rate for Payer: Networks By Design Commercial |
$1,587.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.70
|
|
|
HC POLYSOM LT 6 YRS CPAP/BILVL
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
903600043
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$6,129.81 |
| Rate for Payer: Adventist Health Commercial |
$488.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,993.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,129.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,538.46
|
| Rate for Payer: Blue Shield of California EPN |
$969.47
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,953.60
|
| Rate for Payer: Cigna of CA HMO |
$1,562.88
|
| Rate for Payer: Cigna of CA PPO |
$1,807.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,709.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$2,075.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,197.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,736.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,550.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,918.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$1,831.50
|
| Rate for Payer: Networks By Design Commercial |
$1,587.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,465.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
OP
|
$6,258.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$598.68 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Adventist Health Commercial |
$1,251.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,694.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,371.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,640.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,942.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,484.43
|
| Rate for Payer: Cash Price |
$2,816.10
|
| Rate for Payer: Cash Price |
$2,816.10
|
| Rate for Payer: Cash Price |
$2,816.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,006.40
|
| Rate for Payer: Cigna of CA HMO |
$4,005.12
|
| Rate for Payer: Cigna of CA PPO |
$4,630.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,380.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$5,319.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,632.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$598.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,973.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$661.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$4,693.50
|
| Rate for Payer: Networks By Design Commercial |
$4,067.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$5,319.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,754.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,754.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,327.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
IP
|
$6,258.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,251.60 |
| Max. Negotiated Rate |
$5,632.20 |
| Rate for Payer: Adventist Health Commercial |
$1,251.60
|
| Rate for Payer: Cash Price |
$2,816.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,006.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,380.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,503.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,503.20
|
| Rate for Payer: Galaxy Health WC |
$5,319.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,632.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,973.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,692.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.60
|
| Rate for Payer: Multiplan Commercial |
$4,693.50
|
| Rate for Payer: Networks By Design Commercial |
$4,067.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,319.30
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
OP
|
$7,451.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$615.28 |
| Max. Negotiated Rate |
$7,061.00 |
| Rate for Payer: Adventist Health Commercial |
$1,490.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,014.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,579.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,334.25
|
| Rate for Payer: Blue Shield of California Commercial |
$4,694.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,958.05
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,960.80
|
| Rate for Payer: Cigna of CA HMO |
$4,768.64
|
| Rate for Payer: Cigna of CA PPO |
$5,513.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,215.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,705.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$615.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,731.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$679.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$5,588.25
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,470.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,061.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,722.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,327.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
IP
|
$7,451.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,490.20 |
| Max. Negotiated Rate |
$6,705.90 |
| Rate for Payer: Adventist Health Commercial |
$1,490.20
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,960.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,215.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,980.40
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,705.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,731.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,396.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.20
|
| Rate for Payer: Multiplan Commercial |
$5,588.25
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| 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 |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| 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 |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| 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 |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$233.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Riverside University Health System MISP |
$147.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| 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 |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.00
|
| Rate for Payer: Blue Shield of California Commercial |
$201.60
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$121.61 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$137.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$251.25
|
| 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 |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$234.50
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Riverside University Health System MISP |
$134.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| 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 |
$284.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.75
|
| Rate for Payer: Vantage Medical Group Senior |
$284.75
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
OP
|
$236.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$96.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| 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 |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Riverside University Health System MISP |
$94.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.60
|
| 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 |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
OP
|
$411.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.19 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| 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 |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| 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 |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
IP
|
$411.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
OP
|
$411.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.19 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| 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 |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| 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 |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
IP
|
$411.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.31
|
| Rate for Payer: Blue Shield of California Commercial |
$10.71
|
| Rate for Payer: Blue Shield of California Commercial |
$85.05
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
