|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$141.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.88
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$38.93
|
| Rate for Payer: Blue Shield of California EPN |
$30.62
|
| Rate for Payer: Caremore Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Central Health Plan Commercial |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Media |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.52
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: InnovAge PACE Commercial |
$24.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Prime Health Services Medicare |
$17.51
|
| Rate for Payer: Riverside University Health System MISP |
$18.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.00
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Media |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: InnovAge PACE Commercial |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.02
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC PHOSPHORUS
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS URINE 24 HOURS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: InnovAge PACE Commercial |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.13
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS URINE RANDOM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900912214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.26
|
| 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 |
$1,146.60
|
| Rate for Payer: Caremore Medicare Advantage |
$726.26
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.80
|
| Rate for Payer: Cigna of CA PPO |
$1,414.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Dignity Health Media |
$726.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$726.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.26
|
| Rate for Payer: Galaxy Health WC |
$1,624.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,433.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,191.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$726.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,089.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,274.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.19
|
| Rate for Payer: Multiplan Commercial |
$1,433.25
|
| Rate for Payer: Networks By Design Commercial |
$1,242.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,624.35
|
| Rate for Payer: Prime Health Services Medicare |
$769.84
|
| Rate for Payer: Riverside University Health System MISP |
$798.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,146.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.50
|
| Rate for Payer: United Healthcare All Other HMO |
$955.50
|
| Rate for Payer: United Healthcare HMO Rider |
$955.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$955.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Vantage Medical Group Senior |
$726.26
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$1,719.90 |
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,528.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.40
|
| Rate for Payer: Galaxy Health WC |
$1,624.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,146.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,719.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,274.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$728.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$1,433.25
|
| Rate for Payer: Networks By Design Commercial |
$1,242.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,624.35
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$8,782.20 |
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,903.20
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,717.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,782.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,854.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$5,782.14
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: Cigna of CA PPO |
$7,220.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,540.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: InnovAge PACE Commercial |
$8,673.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,748.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
| Rate for Payer: Prime Health Services Medicare |
$6,129.07
|
| Rate for Payer: Riverside University Health System MISP |
$6,360.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,854.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,782.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,854.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$5,782.14
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: Cigna of CA PPO |
$7,220.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,540.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: InnovAge PACE Commercial |
$8,673.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,748.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
| Rate for Payer: Prime Health Services Medicare |
$6,129.07
|
| Rate for Payer: Riverside University Health System MISP |
$6,360.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,854.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,782.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,854.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$5,782.14
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: Cigna of CA PPO |
$7,220.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,318.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,540.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: InnovAge PACE Commercial |
$8,673.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,748.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
| Rate for Payer: Prime Health Services Medicare |
$6,129.07
|
| Rate for Payer: Riverside University Health System MISP |
$6,360.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,854.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$8,782.20 |
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,903.20
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,717.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$9,758.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.60 |
| Max. Negotiated Rate |
$8,782.20 |
| Rate for Payer: Cash Price |
$4,391.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,903.20
|
| Rate for Payer: Galaxy Health WC |
$8,294.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,854.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,782.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,508.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,717.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.60
|
| Rate for Payer: Multiplan Commercial |
$7,318.50
|
| Rate for Payer: Networks By Design Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,294.30
|
|
|
HC PHP COGNITIVE THERAPY
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804001
|
|
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 PHP COGNITIVE THERAPY
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804001
|
|
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 PHP ED PROCESS GROUP
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804102
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PHP ED PROCESS GROUP
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804102
|
|
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 |
$162.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.92
|
| Rate for Payer: Blue Distinction Transplant |
$201.00
|
| Rate for Payer: Blue Shield of California Commercial |
$210.72
|
| Rate for Payer: Blue Shield of California EPN |
$163.82
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Central Health Plan Commercial |
$268.00
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$301.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$251.25
|
| 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 |
$223.44
|
| 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 |
$67.00
|
| 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 |
$251.25
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| 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 |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$167.50
|
| Rate for Payer: United Healthcare HMO Rider |
$167.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.50
|
| 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 PHP WISDOM GROUP
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804373
|
|
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 |
$110.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.70
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$111.49
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| 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 |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| 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 |
$152.08
|
| 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 |
$45.60
|
| 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 |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| 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 |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| 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 PHP WISDOM GROUP
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804373
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
IP
|
$108,716.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,743.20 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: Galaxy Health WC |
$92,408.60
|
| Rate for Payer: Global Benefits Group Commercial |
$65,229.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$97,844.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72,513.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,420.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,743.20
|
| Rate for Payer: Multiplan Commercial |
$81,537.00
|
| Rate for Payer: Networks By Design Commercial |
$70,665.40
|
| Rate for Payer: Prime Health Services Commercial |
$92,408.60
|
|
