|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.73
|
| Rate for Payer: Blue Shield of California Commercial |
$418.19
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.96
|
| Rate for Payer: InnovAge PACE Commercial |
$270.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Riverside University Health System MISP |
$216.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$486.90 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.73
|
| Rate for Payer: Blue Shield of California Commercial |
$418.19
|
| Rate for Payer: Blue Shield of California EPN |
$272.66
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Central Health Plan Commercial |
$432.80
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.96
|
| Rate for Payer: InnovAge PACE Commercial |
$270.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Riverside University Health System MISP |
$216.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.51
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$18.26
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC POLYS MICRO EXAM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
|
|
HC POLYSOM LT 6 YRS 4/GT PARAMTRS
|
Facility
|
IP
|
$5,746.00
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
903600042
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,149.20 |
| Max. Negotiated Rate |
$5,171.40 |
| Rate for Payer: Adventist Health Commercial |
$1,149.20
|
| Rate for Payer: Cash Price |
$3,160.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,596.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,298.40
|
| Rate for Payer: Galaxy Health WC |
$4,884.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,171.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,189.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,556.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.20
|
| Rate for Payer: Multiplan Commercial |
$4,309.50
|
| Rate for Payer: Networks By Design Commercial |
$3,734.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,884.10
|
|
|
HC POLYSOM LT 6 YRS 4/GT PARAMTRS
|
Facility
|
OP
|
$5,746.00
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
903600042
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$5,763.32 |
| Rate for Payer: Adventist Health Commercial |
$1,149.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,292.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,489.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,763.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,374.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,487.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,281.16
|
| Rate for Payer: Cash Price |
$3,160.30
|
| Rate for Payer: Cash Price |
$3,160.30
|
| Rate for Payer: Cash Price |
$3,160.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,596.80
|
| Rate for Payer: Cigna of CA HMO |
$3,677.44
|
| Rate for Payer: Cigna of CA PPO |
$4,252.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$4,884.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,171.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,628.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,832.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,798.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,732.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$4,309.50
|
| Rate for Payer: Networks By Design Commercial |
$3,734.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,884.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,370.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,421.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,447.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,447.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC POLYSOM LT 6 YRS CPAP/BILVL
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
903600043
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$6,129.81 |
| Rate for Payer: Adventist Health Commercial |
$488.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,292.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,483.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,129.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,434.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,482.29
|
| Rate for Payer: Blue Shield of California EPN |
$969.47
|
| Rate for Payer: Cash Price |
$1,343.10
|
| Rate for Payer: Cash Price |
$1,343.10
|
| Rate for Payer: Cash Price |
$1,343.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,953.60
|
| Rate for Payer: Cigna of CA HMO |
$1,562.88
|
| Rate for Payer: Cigna of CA PPO |
$1,807.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$2,075.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,197.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,736.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,732.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$1,831.50
|
| Rate for Payer: Networks By Design Commercial |
$1,587.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,370.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,421.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,465.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC POLYSOM LT 6 YRS CPAP/BILVL
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
903600043
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$2,197.80 |
| Rate for Payer: Adventist Health Commercial |
$488.40
|
| Rate for Payer: Cash Price |
$1,343.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,953.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.80
|
| Rate for Payer: EPIC Health Plan Senior |
$976.80
|
| Rate for Payer: Galaxy Health WC |
$2,075.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,197.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,628.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,511.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.40
|
| Rate for Payer: Multiplan Commercial |
$1,831.50
|
| Rate for Payer: Networks By Design Commercial |
$1,587.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,075.70
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
OP
|
$6,258.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$5,632.20 |
| Rate for Payer: Adventist Health Commercial |
$1,251.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,292.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,800.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,371.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,675.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3,798.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,484.43
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,006.40
|
| Rate for Payer: Cigna of CA HMO |
$4,005.12
|
| Rate for Payer: Cigna of CA PPO |
$4,630.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$5,319.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,632.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$598.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,174.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,732.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$4,693.50
|
| Rate for Payer: Networks By Design Commercial |
$4,067.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,319.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,370.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,421.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,754.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,754.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
IP
|
$6,258.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,251.60 |
| Max. Negotiated Rate |
$5,632.20 |
| Rate for Payer: Adventist Health Commercial |
$1,251.60
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,503.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,503.20
|
| Rate for Payer: Galaxy Health WC |
$5,319.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,754.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,632.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,174.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,384.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,873.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,251.60
|
| Rate for Payer: Multiplan Commercial |
$4,693.50
|
| Rate for Payer: Networks By Design Commercial |
$4,067.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,319.30
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
OP
|
$7,451.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$6,705.90 |
| Rate for Payer: Adventist Health Commercial |
$1,490.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,292.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,524.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,579.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,375.97
|
| Rate for Payer: Blue Shield of California Commercial |
$4,522.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,958.05
|
| Rate for Payer: Cash Price |
$4,098.05
|
| Rate for Payer: Cash Price |
$4,098.05
|
| Rate for Payer: Cash Price |
$4,098.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,960.80
|
| Rate for Payer: Cigna of CA HMO |
$4,768.64
|
| Rate for Payer: Cigna of CA PPO |
$5,513.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.14
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.70
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,705.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,120.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$615.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,292.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,732.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,732.22
|
| Rate for Payer: Multiplan Commercial |
$5,588.25
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,370.26
|
| Rate for Payer: Riverside University Health System MISP |
$1,421.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,470.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,292.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
IP
|
$7,451.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,490.20 |
| Max. Negotiated Rate |
$6,705.90 |
| Rate for Payer: Adventist Health Commercial |
$1,490.20
|
| Rate for Payer: Cash Price |
$4,098.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,960.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,980.40
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,705.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,838.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,612.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,490.20
|
| Rate for Payer: Multiplan Commercial |
$5,588.25
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$150.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$223.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$276.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: Cigna of CA HMO |
$235.52
|
| Rate for Payer: Cigna of CA PPO |
$272.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$312.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$312.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.96
|
| Rate for Payer: InnovAge PACE Commercial |
$184.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
| Rate for Payer: Riverside University Health System MISP |
$147.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$312.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$312.80
|
| Rate for Payer: Vantage Medical Group Senior |
$312.80
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Adventist Health Commercial |
$73.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Central Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$147.20
|
| Rate for Payer: Galaxy Health WC |
$312.80
|
| Rate for Payer: Global Benefits Group Commercial |
$220.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$331.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$239.20
|
| Rate for Payer: Prime Health Services Commercial |
$312.80
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$194.24
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Central Health Plan Commercial |
$256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.64 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$137.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$203.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$251.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$284.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: InnovAge PACE Commercial |
$167.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$234.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$234.50
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Riverside University Health System MISP |
$134.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.75
|
| Rate for Payer: Vantage Medical Group Senior |
$284.75
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$223.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
