|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,314.91 |
| Max. Negotiated Rate |
$30,945.95 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,314.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,348.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,746.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,629.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,744.68
|
| Rate for Payer: Blue Shield of California Commercial |
$18,339.90
|
| Rate for Payer: Blue Shield of California EPN |
$11,994.96
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: Central Health Plan Commercial |
$24,171.20
|
| Rate for Payer: Cigna of CA HMO |
$19,336.96
|
| Rate for Payer: Cigna of CA PPO |
$22,358.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,746.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,825.13
|
| Rate for Payer: EPIC Health Plan Senior |
$4,314.91
|
| Rate for Payer: Galaxy Health WC |
$25,681.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18,128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,076.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,014.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,314.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,472.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,945.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,314.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,042.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,781.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,781.98
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: Networks By Design Commercial |
$19,639.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,314.91
|
| Rate for Payer: Prime Health Services Commercial |
$25,681.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,573.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,746.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,339.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11,037.17
|
| Rate for Payer: United Healthcare HMO Rider |
$10,798.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,895.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,314.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,746.40
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$6,042.80 |
| Max. Negotiated Rate |
$27,192.60 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23,355.42
|
| Rate for Payer: Blue Shield of California EPN |
$15,227.86
|
| Rate for Payer: Cash Price |
$13,596.30
|
| Rate for Payer: Central Health Plan Commercial |
$24,171.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,085.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,085.60
|
| Rate for Payer: Galaxy Health WC |
$25,681.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18,128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,152.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,511.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,702.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,042.80
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: Networks By Design Commercial |
$19,639.10
|
| Rate for Payer: Prime Health Services Commercial |
$25,681.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,339.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11,037.17
|
| Rate for Payer: United Healthcare HMO Rider |
$10,798.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,895.08
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.00 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$317.00
|
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.00
|
| Rate for Payer: EPIC Health Plan Senior |
$634.00
|
| Rate for Payer: Galaxy Health WC |
$1,347.25
|
| Rate for Payer: Global Benefits Group Commercial |
$951.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,426.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$981.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.75
|
| Rate for Payer: Networks By Design Commercial |
$1,030.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,347.25
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$317.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$962.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.05
|
| Rate for Payer: Blue Shield of California Commercial |
$962.10
|
| Rate for Payer: Blue Shield of California EPN |
$629.25
|
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.00
|
| Rate for Payer: Cigna of CA HMO |
$1,014.40
|
| Rate for Payer: Cigna of CA PPO |
$1,172.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,347.25
|
| Rate for Payer: Global Benefits Group Commercial |
$951.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,426.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,188.75
|
| Rate for Payer: Networks By Design Commercial |
$1,030.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,347.25
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$951.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$951.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$593.73 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$593.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.22
|
| Rate for Payer: Blue Shield of California Commercial |
$356.40
|
| Rate for Payer: Blue Shield of California EPN |
$324.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$472.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Medicare |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SMIC/ID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$40.06
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.56
|
| Rate for Payer: Blue Shield of California Commercial |
$59.88
|
| Rate for Payer: Blue Shield of California EPN |
$39.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$64.77
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$65.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.38
|
| Rate for Payer: Blue Shield of California Commercial |
$97.15
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$64.77
|
| Rate for Payer: Blue Shield of California EPN |
$42.29
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.10
|
| Rate for Payer: EPIC Health Plan Senior |
$37.85
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$62.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: InnovAge PACE Commercial |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.72
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.85
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Medicare |
$40.12
|
| Rate for Payer: Riverside University Health System MISP |
$41.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$110.79 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.48
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SNARE BRAUN MULTI-SNARE
|
Facility
|
OP
|
$1,283.99
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$779.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$706.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$962.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$621.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.09
|
| Rate for Payer: Blue Shield of California Commercial |
$784.52
|
| Rate for Payer: Blue Shield of California EPN |
$512.31
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,027.19
|
| Rate for Payer: Cigna of CA HMO |
$821.75
|
| Rate for Payer: Cigna of CA PPO |
$950.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,091.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,091.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$513.60
|
| Rate for Payer: Galaxy Health WC |
$1,091.39
|
| Rate for Payer: Global Benefits Group Commercial |
$770.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.59
|
| Rate for Payer: InnovAge PACE Commercial |
$642.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$794.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$898.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$898.79
|
| Rate for Payer: Multiplan Commercial |
$962.99
|
| Rate for Payer: Networks By Design Commercial |
$834.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.39
|
| Rate for Payer: Riverside University Health System MISP |
$513.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$642.00
|
| Rate for Payer: United Healthcare HMO Rider |
$642.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,091.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,091.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,091.39
|
|
|
HC SNARE BRAUN MULTI-SNARE
|
Facility
|
IP
|
$1,283.99
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,155.59 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,027.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$513.60
|
| Rate for Payer: Galaxy Health WC |
$1,091.39
|
| Rate for Payer: Global Benefits Group Commercial |
$770.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$794.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$962.99
|
| Rate for Payer: Networks By Design Commercial |
$834.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.39
|
|
|
HC SNARE EN MERIT EN2007030
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$688.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$834.55
|
| Rate for Payer: Blue Shield of California Commercial |
$868.23
|
| Rate for Payer: Blue Shield of California EPN |
$566.98
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: Cigna of CA HMO |
$909.44
|
| Rate for Payer: Cigna of CA PPO |
$1,051.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,207.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: InnovAge PACE Commercial |
$710.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.70
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
| Rate for Payer: Riverside University Health System MISP |
$568.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.50
|
| Rate for Payer: United Healthcare All Other HMO |
$710.50
|
| Rate for Payer: United Healthcare HMO Rider |
$710.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$710.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.85
|
|
|
HC SNARE EN MERIT EN2007030
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Adventist Health Commercial |
$284.20
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
|
|
HC SNARE ONE MERIT ONE2000
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$907.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$822.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,121.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$723.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$878.01
|
| Rate for Payer: Blue Shield of California Commercial |
$913.45
|
| Rate for Payer: Blue Shield of California EPN |
$596.50
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| Rate for Payer: Cigna of CA HMO |
$956.80
|
| Rate for Payer: Cigna of CA PPO |
$1,106.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,270.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,345.50
|
| Rate for Payer: InnovAge PACE Commercial |
$747.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,046.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,046.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: Networks By Design Commercial |
$971.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
| Rate for Payer: Riverside University Health System MISP |
$598.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Other HMO |
$747.50
|
| Rate for Payer: United Healthcare HMO Rider |
$747.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$747.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,270.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,270.75
|
|
|
HC SNARE ONE MERIT ONE2000
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$1,345.50 |
| Rate for Payer: Adventist Health Commercial |
$299.00
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.00
|
| Rate for Payer: EPIC Health Plan Senior |
$598.00
|
| Rate for Payer: Galaxy Health WC |
$1,270.75
|
| Rate for Payer: Global Benefits Group Commercial |
$897.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,345.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.00
|
| Rate for Payer: Multiplan Commercial |
$1,121.25
|
| Rate for Payer: Networks By Design Commercial |
$971.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,270.75
|
|
|
HC SNARE ONE MERIT ONE700
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,934.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$967.20
|
| Rate for Payer: EPIC Health Plan Senior |
$967.20
|
| Rate for Payer: Galaxy Health WC |
$2,055.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,450.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,176.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,612.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$921.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,496.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
| Rate for Payer: Networks By Design Commercial |
$1,571.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,055.30
|
|
