|
HC NEUROSTIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$125,023.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906820310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,004.60 |
| Max. Negotiated Rate |
$106,269.55 |
| Rate for Payer: Adventist Health Commercial |
$25,004.60
|
| Rate for Payer: Cash Price |
$68,762.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,009.20
|
| Rate for Payer: EPIC Health Plan Senior |
$50,009.20
|
| Rate for Payer: Galaxy Health WC |
$106,269.55
|
| Rate for Payer: Global Benefits Group Commercial |
$75,013.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83,390.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47,633.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77,389.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30,005.52
|
| Rate for Payer: Multiplan Commercial |
$100,018.40
|
| Rate for Payer: Networks By Design Commercial |
$81,264.95
|
| Rate for Payer: Prime Health Services Commercial |
$106,269.55
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906810429
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$4,312.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,229.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,853.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL SENS LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0429T
|
| Hospital Charge Code |
906820308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEUROSTIM REMOVAL STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906820309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
IP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$11,490.30 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Cash Price |
$7,434.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,244.32
|
| Rate for Payer: Multiplan Commercial |
$10,814.40
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.34
|
| Rate for Payer: Cash Price |
$58.52
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$58.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.51
|
| Rate for Payer: Blue Shield of California Commercial |
$195.84
|
| Rate for Payer: Blue Shield of California EPN |
$129.28
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.22
|
| Rate for Payer: Blue Shield of California EPN |
$74.74
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.22
|
| Rate for Payer: Blue Shield of California EPN |
$74.74
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.47
|
| Rate for Payer: Blue Shield of California Commercial |
$155.21
|
| Rate for Payer: Blue Shield of California EPN |
$102.54
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$147.18
|
| Rate for Payer: Blue Shield of California EPN |
$97.24
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$7,426.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,832.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$566.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,132.80
|
| Rate for Payer: Galaxy Health WC |
$2,407.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,753.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.68
|
| Rate for Payer: Multiplan Commercial |
$2,265.60
|
| Rate for Payer: Networks By Design Commercial |
$1,840.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,407.20
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$5,594.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$1,118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,076.70
|
| Rate for Payer: Cash Price |
$3,076.70
|
| Rate for Payer: Cash Price |
$3,076.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,237.60
|
| Rate for Payer: Galaxy Health WC |
$4,754.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,356.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,731.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,462.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.56
|
| Rate for Payer: Multiplan Commercial |
$4,475.20
|
| Rate for Payer: Networks By Design Commercial |
$3,636.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,754.90
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| 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 HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| 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 |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| 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 |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| 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
|
|
