|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$143,776.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79,076.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107,832.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69,616.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$79,076.80
|
| Rate for Payer: Cash Price |
$79,076.80
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: Cigna of CA HMO |
$92,016.64
|
| Rate for Payer: Cigna of CA PPO |
$106,394.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$122,209.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122,209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: InnovAge PACE Commercial |
$71,888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95,898.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,778.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88,997.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100,643.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,643.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
| Rate for Payer: Riverside University Health System MISP |
$57,510.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122,209.60
|
| Rate for Payer: Vantage Medical Group Senior |
$122,209.60
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$143,776.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28,755.20 |
| Max. Negotiated Rate |
$129,398.40 |
| Rate for Payer: Adventist Health Commercial |
$28,755.20
|
| Rate for Payer: Cash Price |
$79,076.80
|
| Rate for Payer: Central Health Plan Commercial |
$115,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$57,510.40
|
| Rate for Payer: Galaxy Health WC |
$122,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$86,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$129,398.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95,898.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,778.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88,997.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,755.20
|
| Rate for Payer: Multiplan Commercial |
$107,832.00
|
| Rate for Payer: Networks By Design Commercial |
$93,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$122,209.60
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$95,194.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$85,674.60 |
| Rate for Payer: Adventist Health Commercial |
$19,038.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52,356.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71,395.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,092.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,907.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$52,356.70
|
| Rate for Payer: Cash Price |
$52,356.70
|
| Rate for Payer: Central Health Plan Commercial |
$76,155.20
|
| Rate for Payer: Cigna of CA HMO |
$60,924.16
|
| Rate for Payer: Cigna of CA PPO |
$70,443.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$80,914.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80,914.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38,077.60
|
| Rate for Payer: Galaxy Health WC |
$80,914.90
|
| Rate for Payer: Global Benefits Group Commercial |
$57,116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$85,674.60
|
| Rate for Payer: InnovAge PACE Commercial |
$47,597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63,494.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,268.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58,925.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,038.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66,635.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,635.80
|
| Rate for Payer: Multiplan Commercial |
$71,395.50
|
| Rate for Payer: Networks By Design Commercial |
$61,876.10
|
| Rate for Payer: Prime Health Services Commercial |
$80,914.90
|
| Rate for Payer: Riverside University Health System MISP |
$38,077.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57,116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80,914.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80,914.90
|
| Rate for Payer: Vantage Medical Group Senior |
$80,914.90
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$95,194.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19,038.80 |
| Max. Negotiated Rate |
$85,674.60 |
| Rate for Payer: Adventist Health Commercial |
$19,038.80
|
| Rate for Payer: Cash Price |
$52,356.70
|
| Rate for Payer: Central Health Plan Commercial |
$76,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38,077.60
|
| Rate for Payer: Galaxy Health WC |
$80,914.90
|
| Rate for Payer: Global Benefits Group Commercial |
$57,116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$85,674.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63,494.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,268.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58,925.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,038.80
|
| Rate for Payer: Multiplan Commercial |
$71,395.50
|
| Rate for Payer: Networks By Design Commercial |
$61,876.10
|
| Rate for Payer: Prime Health Services Commercial |
$80,914.90
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,527.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,130.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: InnovAge PACE Commercial |
$7,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,882.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,527.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: InnovAge PACE Commercial |
$7,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,882.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,526.20 |
| Max. Negotiated Rate |
$6,867.90 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.40
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,867.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,907.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,723.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.20
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
OP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$7,166.16 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,369.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,369.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,694.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,481.69
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,962.18
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Cash Price |
$4,197.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,104.80
|
| Rate for Payer: Cigna of CA HMO |
$4,883.84
|
| Rate for Payer: Cigna of CA PPO |
$5,646.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,806.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,898.97
|
| Rate for Payer: EPIC Health Plan Senior |
$4,369.61
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,867.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,166.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,369.61
|
| Rate for Payer: InnovAge PACE Commercial |
$6,554.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,369.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,526.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,855.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,855.28
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,369.61
|
| Rate for Payer: Preferred Health Network WC |
$7,104.27
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,631.79
|
| Rate for Payer: Prime Health Services WC |
$6,891.14
|
| Rate for Payer: Riverside University Health System MISP |
$4,806.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,578.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,815.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,815.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,815.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,815.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,369.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.61
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
OP
|
$15,546.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,550.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,659.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,527.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,130.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: Cigna of CA HMO |
$9,949.44
|
| Rate for Payer: Cigna of CA PPO |
$11,504.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,214.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,214.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: InnovAge PACE Commercial |
$7,773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,882.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,882.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,218.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,214.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13,214.10
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
IP
|
$15,546.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,109.20 |
| Max. Negotiated Rate |
$13,991.40 |
| Rate for Payer: Adventist Health Commercial |
$3,109.20
|
| Rate for Payer: Cash Price |
$8,550.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,218.40
|
| Rate for Payer: Galaxy Health WC |
$13,214.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,327.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,991.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,369.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,923.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,622.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,109.20
|
| Rate for Payer: Multiplan Commercial |
$11,659.50
|
| Rate for Payer: Networks By Design Commercial |
$10,104.90
|
| Rate for Payer: Prime Health Services Commercial |
$13,214.10
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| 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 Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$103.19
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.84
|
| Rate for Payer: Blue Shield of California Commercial |
$103.19
|
| Rate for Payer: Blue Shield of California EPN |
$67.49
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| 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 Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905103156
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.78
|
| Rate for Payer: InnovAge PACE Commercial |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC PHYSICAL PERF TEST 15 MIN PT
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900417750
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
