|
HC NUCLEIC ACID ID VANB
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC NUCLEIC ACID ID VANB
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.79
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: IEHP medi-cal |
$33.08
|
| Rate for Payer: IEHP Medicare Advantage |
$20.05
|
| Rate for Payer: Innovage PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$177.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.79
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: IEHP medi-cal |
$33.08
|
| Rate for Payer: IEHP Medicare Advantage |
$20.05
|
| Rate for Payer: Innovage PACE Commercial |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$22.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID VIM
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$140.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC NUTRITION CLASSES (10)
|
Facility
OP
|
$121.00
|
|
| Hospital Charge Code |
900201844
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.49
|
| Rate for Payer: BCBS Transplant Transplant |
$72.60
|
| Rate for Payer: Blue Shield of California Commercial |
$76.11
|
| Rate for Payer: Blue Shield of California EPN |
$59.17
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.75
|
| Rate for Payer: IEHP medi-cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: Riverside University Health MISP |
$48.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC NUTRITION CLASSES (10)
|
Facility
IP
|
$121.00
|
|
| Hospital Charge Code |
900201844
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC NUTRITION CLASS, INDIVIDUAL
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
900201846
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC NUTRITION CLASS, INDIVIDUAL
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
900201846
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.63
|
| Rate for Payer: BCBS Transplant Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.32
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.50
|
| Rate for Payer: IEHP medi-cal |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: Riverside University Health MISP |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC NUTRITION/METABOLIC ASSESS/TRA
|
Facility
IP
|
$523.00
|
|
| Hospital Charge Code |
902000202
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
|
|
HC NUTRITION/METABOLIC ASSESS/TRA
|
Facility
OP
|
$523.00
|
|
| Hospital Charge Code |
902000202
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$287.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.99
|
| Rate for Payer: BCBS Transplant Transplant |
$313.80
|
| Rate for Payer: Blue Shield of California Commercial |
$328.97
|
| Rate for Payer: Blue Shield of California EPN |
$255.75
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$334.72
|
| Rate for Payer: Cigna of CA PPO |
$387.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$392.25
|
| Rate for Payer: IEHP medi-cal |
$183.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: Riverside University Health MISP |
$209.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC NUTRITION/METABOLIC FOLLOWUP
|
Facility
IP
|
$267.00
|
|
| Hospital Charge Code |
902000203
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC NUTRITION/METABOLIC FOLLOWUP
|
Facility
OP
|
$267.00
|
|
| Hospital Charge Code |
902000203
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.74
|
| Rate for Payer: BCBS Transplant Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$167.94
|
| Rate for Payer: Blue Shield of California EPN |
$130.56
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$200.25
|
| Rate for Payer: IEHP medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: Riverside University Health MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.84
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.98
|
| Rate for Payer: Blue Shield of California EPN |
$104.16
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: IEHP medi-cal |
$74.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Riverside University Health MISP |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.84
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.98
|
| Rate for Payer: Blue Shield of California EPN |
$104.16
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: IEHP medi-cal |
$74.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Riverside University Health MISP |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTRITION THER GRP 30 MIN
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
902000205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
IP
|
$254.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC NUTR THER INIT EVAL 15 MIN
|
Facility
OP
|
$254.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
902000200
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$230.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$139.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.06
|
| Rate for Payer: BCBS Transplant Transplant |
$152.40
|
| Rate for Payer: Blue Shield of California Commercial |
$159.77
|
| Rate for Payer: Blue Shield of California EPN |
$124.21
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$190.50
|
| Rate for Payer: IEHP medi-cal |
$88.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: Riverside University Health MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
IP
|
$136.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC NUTR THER INIT EVAL 30 MN MCAL
|
Facility
OP
|
$136.00
|
|
| Hospital Charge Code |
902000206
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.35
|
| Rate for Payer: BCBS Transplant Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.54
|
| Rate for Payer: Blue Shield of California EPN |
$66.50
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$102.00
|
| Rate for Payer: IEHP medi-cal |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: Riverside University Health MISP |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$198.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.84
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.98
|
| Rate for Payer: Blue Shield of California EPN |
$104.16
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: IEHP medi-cal |
$74.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Riverside University Health MISP |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
|
|
HC NUTR THER-RE EVAL 15 MIN
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
902000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$198.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$198.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$181.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$117.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$117.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.84
|
| Rate for Payer: BCBS Transplant Transplant |
$127.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.98
|
| Rate for Payer: Blue Shield of California EPN |
$104.16
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Cash Price |
$95.85
|
| Rate for Payer: Central Health Plan Commercial |
$170.40
|
| Rate for Payer: Cigna of CA HMO |
$136.32
|
| Rate for Payer: Cigna of CA PPO |
$157.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.20
|
| Rate for Payer: Galaxy Health WC |
$181.05
|
| Rate for Payer: Global Benefits Group Commercial |
$127.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.75
|
| Rate for Payer: IEHP medi-cal |
$74.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.60
|
| Rate for Payer: Multiplan Commercial |
$159.75
|
| Rate for Payer: Networks By Design Commercial |
$138.45
|
| Rate for Payer: Prime Health Services Commercial |
$181.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: Riverside University Health MISP |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.50
|
| Rate for Payer: United Healthcare All Other HMO |
$106.50
|
| Rate for Payer: United Healthcare HMO Rider |
$106.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.05
|
| Rate for Payer: Vantage Medical Group Senior |
$181.05
|
|
|
HC NUTR THER-RE EVAL 30 MN MCAL
|
Facility
IP
|
$136.00
|
|
| Hospital Charge Code |
902000207
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
