|
HC POLYSOM LT 6 YRS CPAP/BILVL
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
903600043
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$499.60 |
| Max. Negotiated Rate |
$6,129.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,306.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,956.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,129.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.82
|
| Rate for Payer: Blue Distinction Transplant |
$1,498.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,214.03
|
| Rate for Payer: Caremore Medicare Advantage |
$1,306.33
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,998.40
|
| Rate for Payer: Cigna of CA HMO |
$1,598.72
|
| Rate for Payer: Cigna of CA PPO |
$1,848.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$2,123.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,498.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,248.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,873.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,142.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,155.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,306.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,959.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,666.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$1,873.50
|
| Rate for Payer: Networks By Design Commercial |
$1,623.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,123.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,384.71
|
| Rate for Payer: Riverside University Health System MISP |
$1,436.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,498.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,498.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$661.33 |
| Max. Negotiated Rate |
$6,702.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,306.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,449.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,371.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,782.30
|
| Rate for Payer: Blue Distinction Transplant |
$3,841.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,956.44
|
| Rate for Payer: Blue Shield of California EPN |
$3,111.37
|
| Rate for Payer: Caremore Medicare Advantage |
$1,306.33
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,121.60
|
| Rate for Payer: Cigna of CA HMO |
$4,097.28
|
| Rate for Payer: Cigna of CA PPO |
$4,737.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$5,441.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,761.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,801.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,142.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,155.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,306.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,959.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
| Rate for Payer: Networks By Design Commercial |
$4,161.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,441.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,384.71
|
| Rate for Payer: Riverside University Health System MISP |
$1,436.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,841.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,841.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC POLYSOMNOGRAM
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
903600031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,280.40 |
| Max. Negotiated Rate |
$5,761.80 |
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,560.80
|
| Rate for Payer: Galaxy Health WC |
$5,441.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,761.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,439.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
| Rate for Payer: Networks By Design Commercial |
$4,161.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,441.70
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
IP
|
$7,623.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,524.60 |
| Max. Negotiated Rate |
$6,860.70 |
| Rate for Payer: Cash Price |
$3,430.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,098.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,049.20
|
| Rate for Payer: Galaxy Health WC |
$6,479.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,860.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,084.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,904.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.60
|
| Rate for Payer: Multiplan Commercial |
$5,717.25
|
| Rate for Payer: Networks By Design Commercial |
$4,954.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,479.55
|
|
|
HC POLYSOMNOGRAM W/NASAL CPAP
|
Facility
|
OP
|
$7,623.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
903600040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$679.67 |
| Max. Negotiated Rate |
$6,860.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,306.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,748.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,579.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,503.67
|
| Rate for Payer: Blue Distinction Transplant |
$4,573.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,711.01
|
| Rate for Payer: Blue Shield of California EPN |
$3,704.78
|
| Rate for Payer: Caremore Medicare Advantage |
$1,306.33
|
| Rate for Payer: Cash Price |
$3,430.35
|
| Rate for Payer: Cash Price |
$3,430.35
|
| Rate for Payer: Cash Price |
$3,430.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,098.40
|
| Rate for Payer: Cigna of CA HMO |
$4,878.72
|
| Rate for Payer: Cigna of CA PPO |
$5,641.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$6,479.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,573.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,860.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,717.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,142.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,155.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,306.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,959.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,084.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$5,717.25
|
| Rate for Payer: Networks By Design Commercial |
$4,954.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,479.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,384.71
|
| Rate for Payer: Riverside University Health System MISP |
$1,436.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,573.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,573.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.75
|
| 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 |
$183.00
|
| 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 |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$195.20
|
| Rate for Payer: Cigna of CA PPO |
$225.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Media |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| 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 |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.80
|
| 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 |
$273.60
|
| 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 |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Media |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Riverside University Health System MISP |
$182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| 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 |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Central Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC POOLING COMPONENTS
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$352.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.69
|
| Rate for Payer: Blue Distinction Transplant |
$205.20
|
| Rate for Payer: Blue Shield of California Commercial |
$211.36
|
| Rate for Payer: Blue Shield of California EPN |
$166.21
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Central Health Plan Commercial |
$273.60
|
| Rate for Payer: Cigna of CA HMO |
$218.88
|
| Rate for Payer: Cigna of CA PPO |
$253.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$256.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: InnovAge PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Networks By Design Commercial |
$222.30
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC POOLING COMPONENTS
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
900904573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Central Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.80
|
| Rate for Payer: Galaxy Health WC |
$290.70
|
| Rate for Payer: Global Benefits Group Commercial |
$205.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$307.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$256.50
|
| Rate for Payer: Networks By Design Commercial |
$222.30
|
| Rate for Payer: Prime Health Services Commercial |
$290.70
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
IP
|
$316.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Central Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.40
|
| Rate for Payer: Galaxy Health WC |
$268.60
|
| Rate for Payer: Global Benefits Group Commercial |
$189.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$284.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.20
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
| Rate for Payer: Networks By Design Commercial |
$205.40
|
| Rate for Payer: Prime Health Services Commercial |
$268.60
|
|
|
HC POOL THRPY W/EXERCISE ADD 15 M
|
Facility
|
OP
|
$316.00
|
|
| Hospital Charge Code |
905103312
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.80
|
| 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 |
$189.60
|
| 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 |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Central Health Plan Commercial |
$252.80
|
| Rate for Payer: Cigna of CA HMO |
$202.24
|
| Rate for Payer: Cigna of CA PPO |
$233.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.60
|
| Rate for Payer: Dignity Health Media |
$268.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.40
|
| Rate for Payer: Galaxy Health WC |
$268.60
|
| Rate for Payer: Global Benefits Group Commercial |
$189.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$284.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$237.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.56
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
| Rate for Payer: Networks By Design Commercial |
$205.40
|
| Rate for Payer: Prime Health Services Commercial |
$268.60
|
| Rate for Payer: Riverside University Health System MISP |
$126.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.60
|
| 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 |
$268.60
|
| Rate for Payer: Vantage Medical Group Senior |
$268.60
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.40
|
| 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 |
$148.80
|
| 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 |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Media |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$186.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.68
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Riverside University Health System MISP |
$99.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| 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 |
$210.80
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC POOL THRPY W EXERCISE ADD 15 MIN MCAL
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
900419081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
IP
|
$388.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC POOL THRPY W/EXERCISE INTL 30
|
Facility
|
OP
|
$388.00
|
|
| Hospital Charge Code |
905103311
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.40
|
| 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 |
$232.80
|
| 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 |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.80
|
| Rate for Payer: Dignity Health Media |
$329.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.08
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Riverside University Health System MISP |
$155.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| 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 |
$329.80
|
| Rate for Payer: Vantage Medical Group Senior |
$329.80
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
OP
|
$388.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.40
|
| 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 |
$232.80
|
| 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 |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.80
|
| Rate for Payer: Dignity Health Media |
$329.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.08
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Riverside University Health System MISP |
$155.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| 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 |
$329.80
|
| Rate for Payer: Vantage Medical Group Senior |
$329.80
|
|
|
HC POOL THRPY W EXERCISE INTL 30 MCAL
|
Facility
|
IP
|
$388.00
|
|
| Hospital Charge Code |
900419080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC PORPHOBILINOGEN QUAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84106
|
| Hospital Charge Code |
900910297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.99
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Media |
$5.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$724.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.13
|
| Rate for Payer: Blue Distinction Transplant |
$790.80
|
| Rate for Payer: Blue Shield of California Commercial |
$988.50
|
| Rate for Payer: Blue Shield of California EPN |
$716.99
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Media |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$988.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$461.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Riverside University Health System MISP |
$527.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$659.00
|
| Rate for Payer: United Healthcare HMO Rider |
$659.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$659.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Blue Shield of California EPN |
$703.81
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.68
|
| Rate for Payer: United Healthcare All Other HMO |
$486.08
|
| Rate for Payer: United Healthcare HMO Rider |
$475.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.94
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$332.75
|
| 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 |
$363.00
|
| 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 |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA PPO |
$447.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Media |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$453.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
