|
HC PHYS THER CASE CONF INITIAL 30 MIN MCAL
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
900419040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
905103308
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.15
|
| 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 |
$67.80
|
| 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 |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Media |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| 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 |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC PHYS THER CASE CONSULT AND REPORT MCAL
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
900419042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.15
|
| 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 |
$67.80
|
| 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 |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$72.32
|
| Rate for Payer: Cigna of CA PPO |
$83.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Media |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$84.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| 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 |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
905103305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.15
|
| 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 |
$151.80
|
| 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 |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Media |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$189.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.73
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Riverside University Health System MISP |
$101.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| 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 |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
900419031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.15
|
| 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 |
$151.80
|
| 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 |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Media |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$189.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.73
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Riverside University Health System MISP |
$101.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| 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 |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.15
|
| 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 |
$151.80
|
| 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 |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Media |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$189.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.73
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Riverside University Health System MISP |
$101.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| 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 |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
905103304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC PHYS THER COMB MODAL/PROC INIT 30 MIN MCAL
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
900419030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.15
|
| 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 |
$151.80
|
| 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 |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Media |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$189.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.73
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Riverside University Health System MISP |
$101.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| 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 |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC PHYS THER ELECT STIM UNATTEND WOUND CARE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900407057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.75
|
| 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 |
$75.00
|
| 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 |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Media |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Riverside University Health System MISP |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| 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 |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
IP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$811.44 |
| Rate for Payer: Blue Shield of California EPN |
$481.45
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Central Health Plan Commercial |
$721.28
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$676.20
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.44
|
| Rate for Payer: United Healthcare All Other HMO |
$332.51
|
| Rate for Payer: United Healthcare HMO Rider |
$325.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.53
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
OP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$811.44 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.19
|
| Rate for Payer: Blue Distinction Transplant |
$540.96
|
| Rate for Payer: Blue Shield of California Commercial |
$676.20
|
| Rate for Payer: Blue Shield of California EPN |
$490.47
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Central Health Plan Commercial |
$721.28
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$766.36
|
| Rate for Payer: Dignity Health Media |
$766.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$676.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$601.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$676.20
|
| Rate for Payer: Networks By Design Commercial |
$450.80
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: Riverside University Health System MISP |
$360.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.80
|
| Rate for Payer: United Healthcare All Other HMO |
$450.80
|
| Rate for Payer: United Healthcare HMO Rider |
$450.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.36
|
| Rate for Payer: Vantage Medical Group Senior |
$766.36
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Blue Shield of California EPN |
$217.87
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.06
|
| Rate for Payer: United Healthcare All Other HMO |
$150.47
|
| Rate for Payer: United Healthcare HMO Rider |
$147.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.64
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.26
|
| Rate for Payer: Blue Distinction Transplant |
$244.80
|
| Rate for Payer: Blue Shield of California Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California EPN |
$221.95
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Central Health Plan Commercial |
$326.40
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Media |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$306.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$306.00
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Riverside University Health System MISP |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Blue Shield of California EPN |
$161.27
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: Cigna of CA HMO |
$211.40
|
| Rate for Payer: Cigna of CA PPO |
$211.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.04
|
| Rate for Payer: United Healthcare All Other HMO |
$111.38
|
| Rate for Payer: United Healthcare HMO Rider |
$108.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.66
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.21
|
| Rate for Payer: Blue Distinction Transplant |
$181.20
|
| Rate for Payer: Blue Shield of California Commercial |
$226.50
|
| Rate for Payer: Blue Shield of California EPN |
$164.29
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: Cigna of CA HMO |
$211.40
|
| Rate for Payer: Cigna of CA PPO |
$211.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.70
|
| Rate for Payer: Dignity Health Media |
$256.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$226.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Networks By Design Commercial |
$151.00
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Riverside University Health System MISP |
$120.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.00
|
| Rate for Payer: United Healthcare All Other HMO |
$151.00
|
| Rate for Payer: United Healthcare HMO Rider |
$151.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.70
|
| Rate for Payer: Vantage Medical Group Senior |
$256.70
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,074.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.29 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,044.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,059.20
|
| Rate for Payer: Cigna of CA PPO |
$3,754.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,312.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,044.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,566.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,805.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,384.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,805.50
|
| Rate for Payer: Networks By Design Commercial |
$3,298.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,044.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,074.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.29 |
| Max. Negotiated Rate |
$5,779.00 |
| 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 |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,044.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,059.20
|
| Rate for Payer: Cigna of CA PPO |
$3,754.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,312.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,044.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,566.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,805.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,384.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,805.50
|
| Rate for Payer: Networks By Design Commercial |
$3,298.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,044.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,537.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,537.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,537.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,074.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,014.80 |
| Max. Negotiated Rate |
$4,566.60 |
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,029.60
|
| Rate for Payer: Galaxy Health WC |
$4,312.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,044.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,566.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,384.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.80
|
| Rate for Payer: Multiplan Commercial |
$3,805.50
|
| Rate for Payer: Networks By Design Commercial |
$3,298.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.90
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,074.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,014.80 |
| Max. Negotiated Rate |
$4,566.60 |
| Rate for Payer: Cash Price |
$2,283.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,029.60
|
| Rate for Payer: Galaxy Health WC |
$4,312.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,044.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,566.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,384.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,933.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,014.80
|
| Rate for Payer: Multiplan Commercial |
$3,805.50
|
| Rate for Payer: Networks By Design Commercial |
$3,298.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.90
|
|
