|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
OP
|
$90.74
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$81.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$77.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.61
|
| Rate for Payer: BCBS Transplant Transplant |
$54.44
|
| Rate for Payer: Blue Shield of California Commercial |
$57.08
|
| Rate for Payer: Blue Shield of California EPN |
$44.37
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Central Health Plan Commercial |
$72.59
|
| Rate for Payer: Cigna of CA HMO |
$58.07
|
| Rate for Payer: Cigna of CA PPO |
$67.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.30
|
| Rate for Payer: Galaxy Health WC |
$77.13
|
| Rate for Payer: Global Benefits Group Commercial |
$54.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$68.06
|
| Rate for Payer: IEHP medi-cal |
$31.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.15
|
| Rate for Payer: Multiplan Commercial |
$68.06
|
| Rate for Payer: Networks By Design Commercial |
$58.98
|
| Rate for Payer: Prime Health Services Commercial |
$77.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$54.44
|
| Rate for Payer: Riverside University Health MISP |
$36.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.37
|
| Rate for Payer: United Healthcare All Other HMO |
$45.37
|
| Rate for Payer: United Healthcare HMO Rider |
$45.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.13
|
| Rate for Payer: Vantage Medical Group Senior |
$77.13
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
OP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$625.86
|
| Rate for Payer: Blue Shield of California EPN |
$486.56
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.30
|
| Rate for Payer: IEHP medi-cal |
$553.66
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Innovage PACE Commercial |
$503.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$355.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$597.00
|
| Rate for Payer: Riverside University Health MISP |
$369.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
IP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
OP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$597.00
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.30
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Innovage PACE Commercial |
$503.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Prime Health Services Medicare |
$355.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$597.00
|
| Rate for Payer: Riverside University Health MISP |
$369.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
IP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Central Health Plan Commercial |
$796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.00
|
| Rate for Payer: Multiplan Commercial |
$746.25
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC WEEKLY PHYSICS
|
Facility
IP
|
$1,919.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$383.80 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Cash Price |
$863.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,535.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$767.60
|
| Rate for Payer: Galaxy Health WC |
$1,631.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,151.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,727.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.80
|
| Rate for Payer: Multiplan Commercial |
$1,439.25
|
| Rate for Payer: Networks By Design Commercial |
$1,247.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,631.15
|
|
|
HC WEEKLY PHYSICS
|
Facility
OP
|
$1,919.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$1,727.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$169.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.48
|
| Rate for Payer: BCBS Transplant Transplant |
$1,151.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.94
|
| Rate for Payer: Blue Shield of California EPN |
$932.63
|
| Rate for Payer: Caremore Medicare Advantage |
$169.53
|
| Rate for Payer: Cash Price |
$863.55
|
| Rate for Payer: Cash Price |
$863.55
|
| Rate for Payer: Cash Price |
$863.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,535.20
|
| Rate for Payer: Cigna of CA HMO |
$1,228.16
|
| Rate for Payer: Cigna of CA PPO |
$1,420.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,631.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,151.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,727.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,439.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$278.03
|
| Rate for Payer: IEHP medi-cal |
$279.72
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Innovage PACE Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,439.25
|
| Rate for Payer: Networks By Design Commercial |
$1,247.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,631.15
|
| Rate for Payer: Prime Health Services Medicare |
$179.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,151.40
|
| Rate for Payer: Riverside University Health MISP |
$186.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,151.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC WET MOUNT
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Caremore Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5.82
|
| Rate for Payer: Innovage PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: Riverside University Health MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC WET MOUNT
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$125.80
|
| Rate for Payer: Blue Shield of California EPN |
$97.80
|
| Rate for Payer: Caremore Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: IEHP medi-cal |
$9.60
|
| Rate for Payer: IEHP Medicare Advantage |
$5.82
|
| Rate for Payer: Innovage PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: Riverside University Health MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.75
|
| Rate for Payer: IEHP medi-cal |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: Riverside University Health MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN OT
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
905103154
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.75
|
| Rate for Payer: IEHP medi-cal |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: Riverside University Health MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN OT
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
905103154
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.75
|
| Rate for Payer: IEHP medi-cal |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: Riverside University Health MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.75
|
| Rate for Payer: IEHP medi-cal |
$57.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: Riverside University Health MISP |
$66.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC WHFO ADD 2ND MP ABDUCT ASSIST
|
Facility
IP
|
$215.00
|
|
| Hospital Charge Code |
903203815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Blue Shield of California EPN |
$114.81
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$150.50
|
| Rate for Payer: Cigna of CA PPO |
$150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$107.50
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC WHFO ADD 2ND MP ABDUCT ASSIST
|
Facility
OP
|
$215.00
|
|
| Hospital Charge Code |
903203815
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$182.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$118.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$118.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.02
|
| Rate for Payer: BCBS Transplant Transplant |
$129.00
|
| Rate for Payer: Blue Shield of California Commercial |
$161.25
|
| Rate for Payer: Blue Shield of California EPN |
$116.96
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$150.50
|
| Rate for Payer: Cigna of CA PPO |
$150.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$182.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$161.25
|
| Rate for Payer: IEHP medi-cal |
$75.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.15
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$107.50
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Riverside University Health MISP |
$86.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.50
|
| Rate for Payer: United Healthcare All Other HMO |
$107.50
|
| Rate for Payer: United Healthcare HMO Rider |
$107.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.75
|
| Rate for Payer: Vantage Medical Group Senior |
$182.75
|
|
|
HC WHFO ADD TO OPPONENS MP EXT S
|
Facility
OP
|
$175.00
|
|
| Hospital Charge Code |
903203825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$96.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.39
|
| Rate for Payer: BCBS Transplant Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$131.25
|
| Rate for Payer: Blue Shield of California EPN |
$95.20
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.25
|
| Rate for Payer: IEHP medi-cal |
$61.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$87.50
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC WHFO ADD TO OPPONENS MP EXT S
|
Facility
IP
|
$175.00
|
|
| Hospital Charge Code |
903203825
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Blue Shield of California EPN |
$93.45
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$122.50
|
| Rate for Payer: Cigna of CA PPO |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$87.50
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC WHFO ADD TO OPPONENS, SPRNG SW
|
Facility
OP
|
$180.00
|
|
| Hospital Charge Code |
903203840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.34
|
| Rate for Payer: BCBS Transplant Transplant |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$135.00
|
| Rate for Payer: Blue Shield of California EPN |
$97.92
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135.00
|
| Rate for Payer: IEHP medi-cal |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90.00
|
| Rate for Payer: United Healthcare HMO Rider |
$90.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC WHFO ADD TO OPPONENS, SPRNG SW
|
Facility
IP
|
$180.00
|
|
| Hospital Charge Code |
903203840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Blue Shield of California EPN |
$96.12
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$126.00
|
| Rate for Payer: Cigna of CA PPO |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$90.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
