|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$341.00
|
| Rate for Payer: United Healthcare HMO Rider |
$341.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$341.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$200.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$330.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$400.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Central Health Plan Commercial |
$642.40
|
| Rate for Payer: Cigna of CA HMO |
$513.92
|
| Rate for Payer: Cigna of CA PPO |
$594.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$682.55
|
| Rate for Payer: Global Benefits Group Commercial |
$481.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$722.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$521.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$682.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$481.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$401.50
|
| Rate for Payer: United Healthcare All Other HMO |
$401.50
|
| Rate for Payer: United Healthcare HMO Rider |
$401.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Central Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.20
|
| Rate for Payer: EPIC Health Plan Senior |
$321.20
|
| Rate for Payer: Galaxy Health WC |
$682.55
|
| Rate for Payer: Global Benefits Group Commercial |
$481.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$722.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.60
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| Rate for Payer: Networks By Design Commercial |
$521.95
|
| Rate for Payer: Prime Health Services Commercial |
$682.55
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$722.70 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Central Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.20
|
| Rate for Payer: EPIC Health Plan Senior |
$321.20
|
| Rate for Payer: Galaxy Health WC |
$682.55
|
| Rate for Payer: Global Benefits Group Commercial |
$481.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$722.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.60
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| Rate for Payer: Networks By Design Commercial |
$521.95
|
| Rate for Payer: Prime Health Services Commercial |
$682.55
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$329.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$487.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Cash Price |
$441.65
|
| Rate for Payer: Central Health Plan Commercial |
$642.40
|
| Rate for Payer: Cigna of CA HMO |
$513.92
|
| Rate for Payer: Cigna of CA PPO |
$594.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$682.55
|
| Rate for Payer: Global Benefits Group Commercial |
$481.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$722.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$521.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$682.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$481.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$481.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.35
|
| Rate for Payer: Blue Shield of California Commercial |
$772.30
|
| Rate for Payer: Blue Shield of California EPN |
$504.34
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,074.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: InnovAge PACE Commercial |
$632.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Riverside University Health System MISP |
$505.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$632.00
|
| Rate for Payer: United Healthcare HMO Rider |
$632.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.40
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.35
|
| Rate for Payer: Blue Shield of California Commercial |
$772.30
|
| Rate for Payer: Blue Shield of California EPN |
$504.34
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,074.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: InnovAge PACE Commercial |
$632.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Riverside University Health System MISP |
$505.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$632.00
|
| Rate for Payer: United Healthcare HMO Rider |
$632.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.40
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC UNOS REGISTRATION LIVER
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
904700520
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC UNOS REGISTRATION LIVER
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
904700520
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.35
|
| Rate for Payer: Blue Shield of California Commercial |
$772.30
|
| Rate for Payer: Blue Shield of California EPN |
$504.34
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,074.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: InnovAge PACE Commercial |
$632.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Riverside University Health System MISP |
$505.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$632.00
|
| Rate for Payer: United Healthcare HMO Rider |
$632.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.40
|
|
|
HC UNOS REGISTRATION PANCREAS
|
Facility
|
OP
|
$1,264.00
|
|
| Hospital Charge Code |
904701020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.35
|
| Rate for Payer: Blue Shield of California Commercial |
$772.30
|
| Rate for Payer: Blue Shield of California EPN |
$504.34
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,074.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: InnovAge PACE Commercial |
$632.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Riverside University Health System MISP |
$505.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$632.00
|
| Rate for Payer: United Healthcare HMO Rider |
$632.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,074.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.40
|
|
|
HC UNOS REGISTRATION PANCREAS
|
Facility
|
IP
|
$1,264.00
|
|
| Hospital Charge Code |
904701020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
944000111
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000308
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
|
IP
|
$3,713.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$742.60 |
| Max. Negotiated Rate |
$3,341.70 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Cash Price |
$2,042.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.20
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,298.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
|
|
HC UNSCH EMER DIAL ESRD OP NO CRT
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
940110257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$742.60 |
| Max. Negotiated Rate |
$3,341.70 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,254.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,797.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,180.64
|
| Rate for Payer: Cash Price |
$2,042.15
|
| Rate for Payer: Cash Price |
$2,042.15
|
| Rate for Payer: Cash Price |
$2,042.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,970.40
|
| Rate for Payer: Cigna of CA HMO |
$2,376.32
|
| Rate for Payer: Cigna of CA PPO |
$2,747.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$3,156.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,341.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,476.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: Networks By Design Commercial |
$2,413.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.05
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,227.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.68
|
| Rate for Payer: Blue Shield of California Commercial |
$116.72
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.16
|
| Rate for Payer: InnovAge PACE Commercial |
$75.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Riverside University Health System MISP |
$60.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Blue Shield of California Commercial |
$116.72
|
| Rate for Payer: Blue Shield of California EPN |
$76.10
|
| Rate for Payer: Cash Price |
$83.05
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
