|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC OTOLARYNGOLOGIC EXAM GEN ANEST
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
900501620
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.34 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$391.50
|
| Rate for Payer: United Healthcare All Other HMO |
$391.50
|
| Rate for Payer: United Healthcare HMO Rider |
$391.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.60
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC OT PRELIMINARY EVALUATION
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
905104349
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$524.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$354.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$495.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Central Health Plan Commercial |
$466.40
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$495.55
|
| Rate for Payer: Dignity Health Media |
$495.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$495.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$524.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$437.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.03
|
| Rate for Payer: Multiplan Commercial |
$437.25
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Riverside University Health System MISP |
$233.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$495.55
|
| Rate for Payer: Vantage Medical Group Senior |
$495.55
|
|
|
HC OT RE-EVALUATION
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
|
|
HC OT RE-EVALUATION
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 97168
|
| Hospital Charge Code |
905104008
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$165.91 |
| Max. Negotiated Rate |
$542.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$258.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$512.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$361.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Cash Price |
$271.35
|
| Rate for Payer: Central Health Plan Commercial |
$482.40
|
| Rate for Payer: Cigna of CA HMO |
$385.92
|
| Rate for Payer: Cigna of CA PPO |
$446.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$512.55
|
| Rate for Payer: Dignity Health Media |
$512.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$241.20
|
| Rate for Payer: Galaxy Health WC |
$512.55
|
| Rate for Payer: Global Benefits Group Commercial |
$361.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$542.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$452.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.23
|
| Rate for Payer: Multiplan Commercial |
$452.25
|
| Rate for Payer: Networks By Design Commercial |
$391.95
|
| Rate for Payer: Prime Health Services Commercial |
$512.55
|
| Rate for Payer: Riverside University Health System MISP |
$241.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$361.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$361.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$512.55
|
| Rate for Payer: Vantage Medical Group Senior |
$512.55
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
OP
|
$11.73
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.93
|
| Rate for Payer: Blue Distinction Transplant |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California EPN |
$5.74
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Media |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Riverside University Health System MISP |
$4.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC OTSM POUCH DRAIN BR 1.5"-38MM
|
Facility
|
IP
|
$11.73
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
IP
|
$11.73
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
|
|
HC OTSM POUCH DRN BR 2.125"-55MM
|
Facility
|
OP
|
$11.73
|
|
|
Service Code
|
CPT A5057
|
| Hospital Charge Code |
901698479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.93
|
| Rate for Payer: Blue Distinction Transplant |
$7.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California EPN |
$5.74
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Cash Price |
$5.28
|
| Rate for Payer: Central Health Plan Commercial |
$9.38
|
| Rate for Payer: Cigna of CA HMO |
$7.51
|
| Rate for Payer: Cigna of CA PPO |
$8.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.97
|
| Rate for Payer: Dignity Health Media |
$9.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.69
|
| Rate for Payer: Galaxy Health WC |
$9.97
|
| Rate for Payer: Global Benefits Group Commercial |
$7.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.35
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.62
|
| Rate for Payer: Prime Health Services Commercial |
$9.97
|
| Rate for Payer: Riverside University Health System MISP |
$4.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.86
|
| Rate for Payer: United Healthcare All Other HMO |
$5.86
|
| Rate for Payer: United Healthcare HMO Rider |
$5.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9.97
|
|
|
HC OT TASK GROUP
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC OT TASK GROUP
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804025
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.01
|
| Rate for Payer: Blue Distinction Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.42
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$208.00
|
| Rate for Payer: Cigna of CA PPO |
$240.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$800.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC OUTBACK CATHETER
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Blue Shield of California EPN |
$2,710.05
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,916.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,831.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,674.75
|
|
|
HC OUTBACK CATHETER
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,791.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,791.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,317.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,826.78
|
| Rate for Payer: Blue Distinction Transplant |
$3,045.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,806.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,760.80
|
| Rate for Payer: Cash Price |
$2,283.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,060.00
|
| Rate for Payer: Cigna of CA HMO |
$3,552.50
|
| Rate for Payer: Cigna of CA PPO |
$3,552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,313.75
|
| Rate for Payer: Dignity Health Media |
$4,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,313.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,030.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,030.00
|
| Rate for Payer: Galaxy Health WC |
$4,313.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,045.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,567.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,806.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,776.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,385.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.00
|
| Rate for Payer: Multiplan Commercial |
$3,806.25
|
| Rate for Payer: Networks By Design Commercial |
$2,537.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,313.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,030.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,045.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,045.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,537.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,537.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,537.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,537.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,313.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,313.75
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Blue Shield of California EPN |
$53.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.76
|
| Rate for Payer: United Healthcare All Other HMO |
$36.88
|
| Rate for Payer: United Healthcare HMO Rider |
$36.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.00
|
|
|
HC OUTFLARE WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3390
|
| Hospital Charge Code |
905353390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Media |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$78.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.56
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$33.37
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Caremore Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.35
|
| Rate for Payer: Dignity Health Media |
$8.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.90
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.90
|
| Rate for Payer: InnovAge PACE Commercial |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$9.43
|
| Rate for Payer: Riverside University Health System MISP |
$9.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.79
|
| Rate for Payer: Vantage Medical Group Senior |
$8.90
|
|
|
HC OVA & PARASITES, PRESERVED
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
900911726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.13
|
| Rate for Payer: Blue Distinction Transplant |
$17.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18.24
|
| Rate for Payer: Blue Shield of California EPN |
$14.18
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Media |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.72
|
| Rate for Payer: Blue Distinction Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.87
|
| Rate for Payer: Blue Shield of California EPN |
$14.67
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Media |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900802001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
900800650
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC OXYGEN PER HOUR PACU
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
900100043
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.13
|
| Rate for Payer: Blue Distinction Transplant |
$17.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18.24
|
| Rate for Payer: Blue Shield of California EPN |
$14.18
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.65
|
| Rate for Payer: Dignity Health Media |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Riverside University Health System MISP |
$11.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$24.65
|
|
|
HC P32 CHROMIC PHOSPHATE PER MCI
|
Facility
|
IP
|
$29,723.00
|
|
|
Service Code
|
CPT A9564
|
| Hospital Charge Code |
909301556
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$5,944.60 |
| Max. Negotiated Rate |
$26,750.70 |
| Rate for Payer: Cash Price |
$13,375.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,778.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,889.20
|
| Rate for Payer: Galaxy Health WC |
$25,264.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,833.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,750.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,825.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,324.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,944.60
|
| Rate for Payer: Multiplan Commercial |
$22,292.25
|
| Rate for Payer: Networks By Design Commercial |
$19,319.95
|
| Rate for Payer: Prime Health Services Commercial |
$25,264.55
|
|
