|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
OP
|
$108,716.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,023.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59,793.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,793.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$65,229.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: Cigna of CA PPO |
$80,449.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Media |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$81,537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,050.60
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$43,486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65,229.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
OP
|
$23,100.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,974.00 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,028.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,635.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,705.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,705.00
|
| 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 |
$13,860.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Central Health Plan Commercial |
$18,480.00
|
| Rate for Payer: Cigna of CA PPO |
$17,094.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,635.00
|
| Rate for Payer: Dignity Health Media |
$19,635.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,635.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,240.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,240.00
|
| Rate for Payer: Galaxy Health WC |
$19,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,860.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,790.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,325.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,085.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,407.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,801.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,620.00
|
| Rate for Payer: Multiplan Commercial |
$17,325.00
|
| Rate for Payer: Networks By Design Commercial |
$15,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,635.00
|
| Rate for Payer: Riverside University Health System MISP |
$9,240.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,860.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,635.00
|
| Rate for Payer: Vantage Medical Group Senior |
$19,635.00
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
IP
|
$23,100.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,620.00 |
| Max. Negotiated Rate |
$20,790.00 |
| Rate for Payer: Cash Price |
$10,395.00
|
| Rate for Payer: Central Health Plan Commercial |
$18,480.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,240.00
|
| Rate for Payer: Galaxy Health WC |
$19,635.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,860.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,790.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,407.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,801.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,620.00
|
| Rate for Payer: Multiplan Commercial |
$17,325.00
|
| Rate for Payer: Networks By Design Commercial |
$15,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,635.00
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$108,716.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
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
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$108,716.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,736.00 |
| Max. Negotiated Rate |
$97,844.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,023.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59,793.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,793.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$65,229.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Cash Price |
$48,922.20
|
| Rate for Payer: Central Health Plan Commercial |
$86,972.80
|
| Rate for Payer: Cigna of CA PPO |
$80,449.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92,408.60
|
| Rate for Payer: Dignity Health Media |
$92,408.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$92,408.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,486.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$81,537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,050.60
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$43,486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65,229.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92,408.60
|
| Rate for Payer: Vantage Medical Group Senior |
$92,408.60
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$71,980.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,396.00 |
| Max. Negotiated Rate |
$64,782.00 |
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$57,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,792.00
|
| Rate for Payer: Galaxy Health WC |
$61,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,010.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,424.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,396.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
| Rate for Payer: Networks By Design Commercial |
$46,787.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,183.00
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$71,980.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,974.00 |
| Max. Negotiated Rate |
$64,782.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,713.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,183.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,589.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,589.00
|
| 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 |
$43,188.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Cash Price |
$32,391.00
|
| Rate for Payer: Central Health Plan Commercial |
$57,584.00
|
| Rate for Payer: Cigna of CA PPO |
$53,265.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,183.00
|
| Rate for Payer: Dignity Health Media |
$61,183.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,183.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,792.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28,792.00
|
| Rate for Payer: Galaxy Health WC |
$61,183.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,782.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53,985.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,193.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48,010.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,424.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,396.00
|
| Rate for Payer: Multiplan Commercial |
$53,985.00
|
| Rate for Payer: Networks By Design Commercial |
$46,787.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,183.00
|
| Rate for Payer: Riverside University Health System MISP |
$28,792.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,188.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,183.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,183.00
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| 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 |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,379.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
OP
|
$9,451.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,890.20 |
| Max. Negotiated Rate |
$8,505.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,251.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,376.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,676.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,251.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,576.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,583.65
|
| Rate for Payer: Blue Distinction Transplant |
$5,670.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$4,251.23
|
| Rate for Payer: Cash Price |
$4,252.95
|
| Rate for Payer: Cash Price |
$4,252.95
|
| Rate for Payer: Cash Price |
$4,252.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,560.80
|
| Rate for Payer: Cigna of CA PPO |
$6,993.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,376.84
|
| Rate for Payer: Dignity Health Media |
$4,251.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,676.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,739.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,251.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,251.23
|
| Rate for Payer: Galaxy Health WC |
$8,033.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,670.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,505.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,088.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,972.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,014.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,251.23
|
| Rate for Payer: InnovAge PACE Commercial |
$6,376.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,251.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,890.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,696.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,696.65
|
| Rate for Payer: Multiplan Commercial |
$7,088.25
|
| Rate for Payer: Networks By Design Commercial |
$6,143.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,033.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,506.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,676.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,670.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,725.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,725.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,725.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,725.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,376.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,676.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,251.23
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$9,451.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,890.20 |
| Max. Negotiated Rate |
$8,505.90 |
| Rate for Payer: Cash Price |
$4,252.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,560.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,780.40
|
| Rate for Payer: Galaxy Health WC |
$8,033.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,670.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,505.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,303.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,600.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,890.20
|
| Rate for Payer: Multiplan Commercial |
$7,088.25
|
| Rate for Payer: Networks By Design Commercial |
$6,143.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,033.35
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$10,579.50 |
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
OP
|
$11,755.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.00 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,138.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,465.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.25
|
| 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 |
$7,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Cash Price |
$5,289.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,404.00
|
| Rate for Payer: Cigna of CA PPO |
$8,698.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,991.75
|
| Rate for Payer: Dignity Health Media |
$9,991.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,991.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,702.00
|
| Rate for Payer: Galaxy Health WC |
$9,991.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,579.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,816.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,114.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,840.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,478.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,351.00
|
| Rate for Payer: Multiplan Commercial |
$8,816.25
|
| Rate for Payer: Networks By Design Commercial |
$7,640.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,991.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,991.75
|
| Rate for Payer: Vantage Medical Group Senior |
$9,991.75
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
900804626
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.48
|
| Rate for Payer: Blue Distinction Transplant |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.37
|
| Rate for Payer: Blue Shield of California EPN |
$69.50
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
900804625
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.48
|
| Rate for Payer: Blue Distinction Transplant |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.37
|
| Rate for Payer: Blue Shield of California EPN |
$69.50
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$102.60
|
| 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 |
$193.80
|
| Rate for Payer: Dignity Health Media |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.48
|
| 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: Riverside University Health System MISP |
$91.20
|
| 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 |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC PHYSICAL PERF TEST 15 MIN MC
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
900400023
|
|
Hospital Revenue Code
|
420
|
| 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 PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| 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 PHYSICAL PERF TEST 15 MIN MCAL
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
901300076
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$102.60
|
| 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 |
$193.80
|
| Rate for Payer: Dignity Health Media |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.48
|
| 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: Riverside University Health System MISP |
$91.20
|
| 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 |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| 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 PHYSICAL PERF TEST 15 MIN OT
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
905104156
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$102.60
|
| 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 |
$193.80
|
| Rate for Payer: Dignity Health Media |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.48
|
| 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: Riverside University Health System MISP |
$91.20
|
| 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 |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
